Value in Coronary Artery Bypass Grafting (CABG)

Perioperative AMI occurs in approximately 7-15% of cardiac surgery patients and is associated with an increased hospital length of stay (HLOS), hospital cost, and reduced short- and long term patient survival. However, the diagnosis of perioperative AMI can be challenging due to the prevalent elevations of traditional cardiac biomarkers such as Troponin & CK-MB, even in uncomplicated surgery.

Due to its early release mechanism, H-FABP has recently been demonstrated to be a superior independent predictor of post-operative mortality and ventricular dysfunction than both Troponin & CK-MB.

“H-FABP is an Independent Predictor of Death and Ventricular Dysfunction after CABG surgery” 15

Muehlschlegel JD, Perry TE, Liu KY, Fox AA, Collard CD, Shernan SK, Body SC. Anesth Analg. 2010;111(5):1101-9.

“H-FABP is superior to cTnI, CK-MB and myoglobin for predicting all-cause mortality up to 5 years after Coronary Artery Bypass Grafting (CABG) surgery.”

Muehlschlegel (Anesth Analg. 2010) conducted a prospective study of 1298 patients undergoing primary CABG with cardiopulmonary bypass (CPB) across two institutions in the USA (Boston & Texas). Blood samples were obtained from all patients at 7 perioperative time points; before anaesthesia, after weaning from CPB, and then once on each of the following 5 mornings.

H-FABP was found to be superior to cTnI, CK-MB and Myoglobin for predicting all-cause mortality up to 5 years after Coronary Artery Bypass Grafting (CABG) surgery. Furthermore, increased H-FABP levels after CPB were independently associated with ventricular dysfunction, and a further increase in the usual peak of H-FABP identified patients at exceptionally increased risk for mortality and increased HLOS.

The faster increase and more rapid clearance of H-FABP, compared with traditional biomarkers of myocardial injury, make it a more sensitive marker for sustained or recurring myocardial injury. The slower release of CK-MB and cTnI generates an inability to discriminate between graft failure with massive tissue necrosis and ischemia reperfusion injury within 24 hours after Coronary Artery Bypass Grafting (CABG) surgery.

5 Year predictive value following CABG

Fig 1: Time course of median biomarker levels following Coronary Artery Bypass Grafting (CABG). Myglobin shown as one-tenth of actual value
How to test H-FABP

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