D-dimer Level is an Early Marker of Ischaemia/ reperfusion Injury After Coronary Artery Bypass Surgery
Keywords: Myocardial reperfusion injury, fibrin fragment D, thrombin
Introduction: Myocardial Ischaemia-Reperfusion (I-R) injury produces a spectrum of clinical cardiovascular outcomes after cardiac surgery. The pathogenesis of I-R injury is complex and involves the activation and amplification of several systemic and local proinflammatory pathways. The process of restoring blood flow to the ischaemic myocardium can induce injury and paradoxically reduce the beneficial effects of myocardial reperfusion. The objective of this study was to determine the correlation between cardiac markers such as the Mb fraction of the creatine kinase (CK-MB), troponin I (cTnI) and D-dimer levels as a marker of myocardial injury secondary to I-R injury after coronary artery bypass surgery. Patients and Methods: Herein, a prospective study was designed that included 50 consecutive coronary artery bypass grafting (CABG) patients. Pre and postoperative blood samples were taken due to study protocol and such markers as Mb fraction of the creatine kinase (CK-MB), troponin I (cTnI) and D-dimer were measured. Results: All three markers were significantly elevated in postoperative blood samples. The D-dimer level reached its peak at the first and another peak at 12th hour postoperatively. However, the peak serum values of CK-MB and cTnI occurred at 6th and 12th hour, respectively. Conclusion: We demonstrated that D-dimer levels as a marker of generated thrombin during reperfusion correlated with other well-known biochemical markers of myocardial damage in the postoperative period. In other words, D-dimer levels may stand as a marker of I-R-induced myocardial damage.