FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 330:670-674 March 10, 1994 Number 10 Next

	Full Text Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Perioperative myocardial infarction is the most common cause of morbidity and mortality in patients who have had noncardiac surgery, but its diagnosis can be difficult. The present study was designed to determine whether the measurement of serum levels of cardiac troponin I, a highly sensitive and specific marker for cardiac injury, would help establish the diagnosis of myocardial infarction.

Methods We obtained preoperative measurements of MB creatine kinase, total creatine kinase, and cardiac troponin I, in addition to base-line electrocardiograms and two-dimensional echocardiograms, in 96 patients undergoing vascular surgery and 12 undergoing spinal surgery. Blood samples were obtained every 6 hours for at least the first 36 hours after surgery, and electrocardiograms were obtained daily; a second echocardiogram was obtained approximately three days after surgery. The appearance of a new abnormality in segmental-wall motion on the postoperative echocardiogram (that is, an abnormality that had not been seen on the preoperative echocardiogram) was considered to be indicative of perioperative infarction.

Results Eight patients who underwent vascular surgery had new abnormalities in segmental-wall motion and received a diagnosis of perioperative infarction. All eight had elevations of cardiac troponin I, and six had elevations of MB creatine kinase. Of the 100 patients without perioperative infarction detected by echocardiography, 19 had elevations of MB creatine kinase, and 1 had a slight elevation of cardiac troponin I.

Conclusions The measurement of cardiac troponin I is a sensitive and specific method for the diagnosis of perioperative myocardial infarction. It avoids the high incidence of false diagnoses associated with the use of MB creatine kinase as a diagnostic marker.

Source Information

From the Cardiovascular Division (J.E.A., V.G.D.-R., A.S.J.), the Department of Surgery, Vascular Surgery Section (G.A.S., B.T.A.), the Division of Orthopedic Surgery (K.H.B., L.G.L.), and the Division of Laboratory Medicine (J.H.L.), Washington University School of Medicine, St. Louis; and the Division of Laboratory Medicine, Vanderbilt University, Nashville (G.S.B.).

Address reprint requests to Dr. Jaffe at Washington University School of Medicine, 660 S. Euclid, Box 8086, St. Louis, MO 63110.

Full Text of this Article

Related Letters:

Troponin I in the Diagnosis of Postoperative Myocardial Infarction
Rich M. R., Murphy J. G., Adams J. E., Ladenson J. H., Jaffe A. S.
Extract | Full Text  
N Engl J Med 1994; 331:277, Jul 28, 1994. Correspondence

This article has been cited by other articles:

• Fleisher, L. A., Beckman, J. A., Brown, K. A., Calkins, H., Chaikof, E. L., Fleischmann, K. E., Freeman, W. K., Froehlich, J. B., Kasper, E. K., Kersten, J. R., Riegel, B., Robb, J. F., Smith, S. C. Jr, Jacobs, A. K., Adams, C. D., Anderson, J. L., Antman, E. M., Buller, C. E., Creager, M. A., Ettinger, S. M., Faxon, D. P., Fuster, V., Halperin, J. L., Hiratzka, L. F., Hunt, S. A., Lytle, B. W., Nishimura, R., Ornato, J. P., Page, R. L., Riegel, B., Tarkington, L. G., Yancy, C. W. (2007). ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. J Am Coll Cardiol 50: e159-e242 [Full Text]  
• Fleisher, L. A., Beckman, J. A., Brown, K. A., Calkins, H., Chaikof, E., Fleischmann, K. E., Freeman, W. K., Froehlich, J. B., Kasper, E. K., Kersten, J. R., Riegel, B., Robb, J. F. (2007). ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Circulation 116: e418-e499 [Full Text]  
• Perlstein, T. S., Beckman, J. A. (2007). Peri-operative cardiac biomarker surveillance: a strategy in need of a goal. Vasc Med 12: 211-213  
• Cuthbertson, B. H., Amiri, A. R., Croal, B. L., Rajagopalan, S., Alozairi, O., Brittenden, J., Hillis, G. S. (2007). Utility of B-type natriuretic peptide in predicting perioperative cardiac events in patients undergoing major non-cardiac surgery. Br J Anaesth 99: 170-176 [Abstract] [Full Text]  
• NACB WRITING GROUP MEMBERS, , Morrow, D. A., Cannon, C. P., Jesse, R. L., Newby, L. K., Ravkilde, J., Storrow, A. B., Wu, A. H.B., Christenson, R. H. (2007). National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Clinical Characteristics and Utilization of Biochemical Markers in Acute Coronary Syndromes. Circulation 115: e356-e375 [Full Text]  
• NACB WRITING GROUP MEMBERS, , Morrow, D. A., Cannon, C. P., Jesse, R. L., Newby, L. K., Ravkilde, J., Storrow, A. B., Wu, A. H.B., Christenson, R. H., NACB COMMITTEE MEMBERS, , Christenson, R. H., Apple, F. S., Cannon, C. P., Francis, G., Jesse, R. L., Morrow, D. A., Newby, L. K., Ravkilde, J., Storrow, A. B., Tang, W., Wu, A. H.B. (2007). National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Clinical Characteristics and Utilization of Biochemical Markers in Acute Coronary Syndromes. Clin. Chem. 53: 552-574 [Full Text]  
• Memtsoudis, S. G., Rosenberger, P., Walz, J. M. (2007). Critical Care Issues in the Patient After Major Joint Replacement. J Intensive Care Med 22: 92-104 [Abstract]  
• Fisher, A. A., Southcott, E. K., Srikusalanukul, W., Davis, M. W., Hickman, P. E., Potter, J. M., Smith, P. N. (2007). Relationships between Myocardial Injury, All-cause Mortality, Vitamin D, PTH, and Biochemical Bone Turnover Markers in Older Patients with Hip Fractures. Annals of Clinical & Laboratory Science 37: 222-232 [Abstract] [Full Text]  
• Raux, M., Godet, G., Isnard, R., Mergoni, P., Goarin, J.-P., Bertrand, M., Fleron, M., Coriat, P., Riou, B. (2006). Low negative predictive value of dobutamine stress echocardiography before abdominal aortic surgery. Br J Anaesth 97: 770-776 [Abstract] [Full Text]  
• Howard-Alpe, G. M., Sear, J. W., Foex, P. (2006). Methods of detecting atherosclerosis in non-cardiac surgical patients; the role of biochemical markers. Br J Anaesth 97: 758-769 [Abstract] [Full Text]  
• Adesanya, A. O., de Lemos, J. A., Greilich, N. B., Whitten, C. W. (2006). Management of perioperative myocardial infarction in noncardiac surgical patients.. Chest 130: 584-596 [Abstract] [Full Text]  
• Okmen, E., Cam, N., Sanli, A., Unal, S., Tartan, Z., Vural, M. (2006). Cardiac Troponin I Increase After Successful Percutaneous Coronary Angioplasty: Predictors and Long-Term Prognostic Value. ANGIOLOGY 57: 161-169 [Abstract]  
• Koramaz, I., Pulathan, Z., Usta, S., Karahan, S. C., Alver, A., Yaris, E., Kalyoncu, N. I., Ozcan, F. (2006). Cardioprotective Effect of Cold-Blood Cardioplegia Enriched with N-Acetylcysteine During Coronary Artery Bypass Grafting. Ann. Thorac. Surg. 81: 613-618 [Abstract] [Full Text]  
• Simon, C., Roscitano, A., Capuano, F., Benedetto, U., Di Nucci, G., Tonelli, E., Sinatra, R. (2006). Effect of topic defibrillation on serum markers of myocardial damage. ICVTS 5: 75-77 [Abstract] [Full Text]  
• Minkin, R., Cotiga, D., Noack, S., Dobrescu, A., Homel, P., Shapiro, J. M. (2005). Use of Admission Troponin in Critically Ill Medical Patients. J Intensive Care Med 20: 286-290 [Abstract]  
• Babuin, L., Jaffe, A. S. (2005). Troponin: the biomarker of choice for the detection of cardiac injury. CMAJ 173: 1191-1202 [Abstract] [Full Text]  
• Thielmann, M., Massoudy, P., Schmermund, A., Neuhauser, M., Marggraf, G., Kamler, M., Herold, U., Aleksic, I., Mann, K., Haude, M., Heusch, G., Erbel, R., Jakob, H. (2005). Diagnostic discrimination between graft-related and non-graft-related perioperative myocardial infarction with cardiac troponin I after coronary artery bypass surgery. Eur Heart J 26: 2440-2447 [Abstract] [Full Text]  
• Devereaux, P.J., Goldman, L., Yusuf, S., Gilbert, K., Leslie, K., Guyatt, G. H. (2005). Surveillance and prevention of major perioperative ischemic cardiac events in patients undergoing noncardiac surgery: a review. CMAJ 173: 779-788 [Abstract] [Full Text]  
• Priebe, H.-J. (2005). Perioperative myocardial infarction--aetiology and prevention. Br J Anaesth 95: 3-19 [Abstract] [Full Text]  
• Tarnok, A, Bocsi, J, Osmancik, P, Hausler, H-J, Schneider, P, Dahnert, I (2005). Cardiac troponin I release after transcatheter atrial septal defect closure depends on occluder size but not on patient's age. Heart 91: 219-222 [Abstract] [Full Text]  
• Ghansah, J. N., Murphy, J. T. (2004). Complications of Major Aortic and Lower Extremity Vascular Surgery. SEMIN CARDIOTHORAC VASC ANESTH 8: 335-361 [Abstract]  
• Yan, A. T., Yan, R. T., Tan, M., Chow, C.-M., Fitchett, D., Stanton, E., Langer, A., Goodman, S. G., for the Canadian Acute Coronary Syndromes Registr, (2004). Troponin is more useful than creatine kinase in predicting one-year mortality among acute coronary syndrome patients. Eur Heart J 25: 2006-2012 [Abstract] [Full Text]  
• Landesberg, G., Mosseri, M., Shatz, V., Akopnik, I., Bocher, M., Mayer, M., Anner, H., Berlatzky, Y., Weissman, C. (2004). Cardiac troponin after major vascular surgery: The role of perioperative ischemia, preoperative thallium scanning, and coronary revascularization. J Am Coll Cardiol 44: 569-575 [Abstract] [Full Text]  
• Thielmann, M., Massoudy, P., Marggraf, G., Knipp, S., Schmermund, A., Piotrowski, J., Erbel, R., Jakob, H. (2004). Role of troponin I, myoglobin, and creatine kinase for the detection of early graft failure following coronary artery bypass grafting. Eur. J. Cardiothorac. Surg. 26: 102-109 [Abstract] [Full Text]  
• Priebe, H.-J. (2004). Triggers of perioperative myocardial ischaemia and infarction. Br J Anaesth 93: 9-20 [Abstract] [Full Text]  
• Howell, S. J., Sear, J. W. (2004). Perioperative myocardial injury: individual and population implications. Br J Anaesth 93: 3-8 [Abstract] [Full Text]  
• Kemp, M., Donovan, J., Higham, H., Hooper, J. (2004). Biochemical markers of myocardial injury. Br J Anaesth 93: 63-73 [Abstract] [Full Text]  
• Filipovic, M., Jeger, R., Probst, C., Girard, T., Pfisterer, M., Gurke, L., Skarvan, K., Seeberger, M. D. (2003). Heart rate variability and cardiac troponin I are incremental and independent predictors of one-year all-cause mortality after major noncardiac surgery in patients at risk of coronary artery disease. J Am Coll Cardiol 42: 1767-1776 [Abstract] [Full Text]  
• Landesberg, G., Shatz, V., Akopnik, I., Wolf, Y. G., Mayer, M., Berlatzky, Y., Weissman, C., Mosseri, M. (2003). Association of cardiac troponin, CK-MB, and postoperative myocardial ischemia with long-term survival after major vascular surgery. J Am Coll Cardiol 42: 1547-1554 [Abstract] [Full Text]  
• Jaffe, A. S. (2003). A small step for man, a leap forward for postoperative management. J Am Coll Cardiol 42: 1555-1557 [Full Text]  
• Samankatiwat, P., Samartzis, I., Lertsithichai, P., Stefanou, D., Punjabi, P. P, Taylor, K. M, Gourlay, T. (2003). Leucocyte depletion in cardiopulmonary bypass: a comparison of four strategies. Perfusion 18: 95-105 [Abstract]  
• Kim, L. J., Martinez, E. A., Faraday, N., Dorman, T., Fleisher, L. A., Perler, B. A., Williams, G. M., Chan, D., Pronovost, P. J. (2002). Cardiac Troponin I Predicts Short-Term Mortality in Vascular Surgery Patients. Circulation 106: 2366-2371 [Abstract] [Full Text]  
• Nass, C., Fleisher, L. A. (2002). Diagnosing Perioperative Myocardial Infarction in Cardioth oracic and Vascular Surgery. SEMIN CARDIOTHORAC VASC ANESTH 6: 219-227 [Abstract]  
• Meier, M. A., Al-Badr, W. H., Cooper, J. V., Kline-Rogers, E. M., Smith, D. E., Eagle, K. A., Mehta, R. H. (2002). The New Definition of Myocardial Infarction: Diagnostic and Prognostic Implications in Patients With Acute Coronary Syndromes. Arch Intern Med 162: 1585-1589 [Abstract] [Full Text]  
• Januzzi, J. L. Jr, Lewandrowski, K., MacGillivray, T. E., Newell, J. B., Kathiresan, S., Servoss, S. J., Lee-Lewandrowski, E. (2002). A comparison of cardiac troponin T and creatine kinase-MB for patient evaluation after cardiac surgery. J Am Coll Cardiol 39: 1518-1523 [Abstract] [Full Text]  
• Eagle, K. A., Berger, P. B., Calkins, H., Chaitman, B. R., Ewy, G. A., Fleischmann, K. E., Fleisher, L. A., Froehlich, J. B., Gusberg, R. J., Leppo, J. A., Ryan, T., Schlant, R. C., Winters, W. L. Jr, Gibbons, R. J., Antman, E. M., Alpert, J. S., Faxon, D. P., Fuster, V., Gregoratos, G., Jacobs, A. K., Hiratzka, L. F., Russell, R. O., Smith, S. C. Jr (2002). ACC/AHA Guideline Update for Perioperative Cardiovascular Evaluation for Noncardiac Surgery--Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Circulation 105: 1257-1267 [Full Text]  
• Eagle, K. A., Berger, P. B., Calkins, H., Chaitman, B. R., Ewy, G. A., Fleischmann, K. E., Fleisher, L. A., Froehlich, J. B., Gusberg, R. J., Leppo, J. A., Ryan, T., Schlant, R. C., Winters, W. L. Jr, Gibbons, R. J., Antman, E. M., Alpert, J. S., Faxon, D. P., Fuster, V., Gregoratos, G., Jacobs, A. K., Hiratzka, L. F., Russell, R. O., Smith, S. C. Jr (2002). ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery--executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) . J Am Coll Cardiol 39: 542-553 [Full Text]  
• Raman, J. S., Bellomo, R., Hayhoe, M., Tsamitros, M., Buxton, B. F. (2001). Metabolic changes and myocardial injury during cardioplegia: a pilot study. Ann. Thorac. Surg. 72: 1566-1571 [Abstract] [Full Text]  
• Jin, F., Chung, F. (2001). Minimizing perioperative adverse events in the elderly{dagger}. Br J Anaesth 87: 608-624 [Abstract] [Full Text]  
• Petzold, T., Feindt, P., Sunderdiek, U., Boeken, U., Fischer, Y., Gams, E. (2001). Heart-type fatty acid binding protein (hFABP) in the diagnosis of myocardial damage in coronary artery bypass grafting. Eur. J. Cardiothorac. Surg. 19: 859-864 [Abstract] [Full Text]  
• Landesberg, G., Mosseri, M., Zahger, D., Wolf, Y., Perouansky, M., Anner, H., Drenger, B., Hasin, Y., Berlatzky, Y., Weissman, C. (2001). Myocardial infarction after vascular surgery: the role of prolonged, stress-induced, ST depression-type ischemia. J Am Coll Cardiol 37: 1839-1845 [Abstract] [Full Text]  
• Rajnoch, C., Chachques, J.-C., Berrebi, A., Bruneval, P., Benoit, M.-O., Carpentier, A. (2001). Cellular therapy reverses myocardial dysfunction. J. Thorac. Cardiovasc. Surg. 121: 871-878 [Abstract] [Full Text]  
• Guler, N., Bilge, M., Eryonucu, B., Uzun, K., Avci, M. E., Dulger, H. (2001). Cardiac Troponin I Levels in Patients with Left Heart Failure and Cor Pulmonale. ANGIOLOGY 52: 317-322 [Abstract]  
• Venge, P., Lindahl, B., Wallentin, L. (2001). New Generation Cardiac Troponin I Assay for the Access Immunoassay System. Clin. Chem. 47: 959-961 [Full Text]  
• Vermes, E., Mesguich, M., Houel, R., Soustelle, C., Le Besnerais, P., Hillion, M.-L., Loisance, D. (2000). Cardiac troponin I release after open heart surgery: a marker of myocardial protection?. Ann. Thorac. Surg. 70: 2087-2090 [Abstract] [Full Text]  
• Dixit, S., Castle, M., Velu, R. P., Swisher, L., Hodge, C., Jaffe, A. S. (2000). Cardiac Involvement in Patients With Acute Neurologic Disease: Confirmation With Cardiac Troponin I. Arch Intern Med 160: 3153-3158 [Abstract] [Full Text]  
• Jaffe, A. S., Ravkilde, J., Roberts, R., Naslund, U., Apple, F. S., Galvani, M., Katus, H. (2000). It's Time for a Change to a Troponin Standard. Circulation 102: 1216-1220 [Full Text]  
• Boriani, G., Biffi, M., Cervi, V., Bronzetti, G., Magagnoli, G., Zannoli, R., Branzi, A. (2000). Evaluation of Myocardial Injury Following Repeated Internal Atrial Shocks by Monitoring Serum Cardiac Troponin I Levels. Chest 118: 342-347 [Abstract] [Full Text]  
• Labarrere, C. A., Nelson, D. R., Cox, C. J., Pitts, D., Kirlin, P., Halbrook, H. (2000). Cardiac-Specific Troponin I Levels and Risk of Coronary Artery Disease and Graft Failure Following Heart Transplantation. JAMA 284: 457-464 [Abstract] [Full Text]  
• ver Elst, K. M., Spapen, H. D., Nguyen, D. N., Garbar, C., Huyghens, L. P., Gorus, F. K. (2000). Cardiac Troponins I and T Are Biological Markers of Left Ventricular Dysfunction in Septic Shock. Clin. Chem. 46: 650-657 [Abstract] [Full Text]  
• Carrier, M., Pellerin, M., Perrault, L. P., Solymoss, B. C., Pelletier, L. C. (2000). Troponin levels in patients with myocardial infarction after coronary artery bypass grafting. Ann. Thorac. Surg. 69: 435-440 [Abstract] [Full Text]  
• Datta, P., Foster, K., Dasgupta, A. (1999). Comparison of Immunoreactivity of Five Human Cardiac Troponin I Assays toward Free and Complexed Forms of the Antigen: Implications for Assay Discordance. Clin. Chem. 45: 2266-2269 [Full Text]  
• Sacks, D. B (1999). Acute coronary ischemia: troponin I and T. Vasc Med 4: 253-256 [Abstract]  
• Fellahi, J.-L., Leger, P., Philippe, E., Arthaud, M., Riou, B., Gandjbakhch, I., Coriat, P. (1999). Pericardial Cardiac Troponin I Release After Coronary Artery Bypass Grafting. Anesth. Analg. 89: 829-829 [Abstract] [Full Text]  
• Immer, F. F., Stocker, F., Seiler, A. M., Pfammatter, J.-P., Bachmann, D., Printzen, G., Carrel, T. (1999). Troponin-I for prediction of early postoperative course after pediatric cardiac surgery. J Am Coll Cardiol 33: 1719-1723 [Abstract] [Full Text]  
• Giuliani, I., Bertinchant, J.-P., Granier, C., Laprade, M., Chocron, S., Toubin, G., Etievent, J.-P., Larue, C., Trinquier, S. (1999). Determination of Cardiac Troponin I Forms in the Blood of Patients with Acute Myocardial Infarction and Patients Receiving Crystalloid or Cold Blood Cardioplegia. Clin. Chem. 45: 213-222 [Abstract] [Full Text]  
• Babatasi, G., Massetti, M., Nataf, P., Fradin, S., Agostini, D., Grollier, G., Gerard, J.-L., Khayat, A. (1998). Minimally invasive coronary surgery: surgical considerations and assessment of cardiac troponin I. Eur. J. Cardiothorac. Surg. 14: S82-S87 [Abstract] [Full Text]  
• Carrier, M., Pellerin, M., Page, P. L., Searle, N. R., Martineau, R., Caron, C., Solymoss, B. C., Pelletier, L. C. (1998). Can L-arginine improve myocardial protection during cardioplegic arrest? Results of a phase I pilot study. Ann. Thorac. Surg. 66: 108-112 [Abstract] [Full Text]  
• Coudrey, L. (1998). The Troponins. Arch Intern Med 158: 1173-1180 [Full Text]  
• De Paulis, R., Colagrande, L., Seddio, F., Piciche, M., de Peppo, A. P., Bassano, C., Tomai, F., Chiariello, L. (1998). Levels of Troponin I and Cardiac Enzymes After Reinfusion of Shed Blood in Coronary Operations. Ann. Thorac. Surg. 65: 1617-1620 [Abstract] [Full Text]  
• Hirsch, R., Dent, C. L., Wood, M. K., Huddleston, C. B., Mendeloff, E. N., Balzer, D. T., Landt, Y., Parvin, C. A., Landt, M., Ladenson, J. H., Canter, C. E. (1998). Patterns and Potential Value of Cardiac Troponin I Elevations After Pediatric Cardiac Operations. Ann. Thorac. Surg. 65: 1394-1399 [Abstract] [Full Text]  
• Martin, G. S., Randall, D. C., Jones, D. (1998). The Obsolescence of Lactate Dehydrogenase Testing. Arch Intern Med 158: 544-544 [Full Text]  
• Sadony, V., Korber, M., Albes, G., Podtschaske, V., Etgen, T., Trosken, T., Ravens, U., Scheulen, M. E. (1998). Cardiac troponin I plasma levels for diagnosis and quantitation of perioperative myocardial damage in patients undergoing coronary artery bypass surgery. Eur. J. Cardiothorac. Surg. 13: 57-65 [Abstract] [Full Text]  
• O'Brien, P. J., Landt, Y., Ladenson, J. H. (1997). Differential reactivity of cardiac and skeletal muscle from various species in a cardiac troponin I immunoassay. Clin. Chem. 43: 2333-2338 [Abstract] [Full Text]  
• Wiklund, R. A., Rosenbaum, S. H. (1997). Anesthesiology- First of Two Parts. NEJM 337: 1132-1141 [Full Text]  
• Katrukha, A. G., Bereznikova, A. V., Esakova, T. V., Pettersson, K., Lovgren, T., Severina, M. E., Pulkki, K., Vuopio-Pulkki, L.-M., Gusev, N. B. (1997). Troponin I is released in bloodstream of patients with acute myocardial infarction not in free form but as complex. Clin. Chem. 43: 1379-1385 [Abstract] [Full Text]  
• Halm, E. A., Browner, W. S., Tubau, J. F., Tateo, I. M., Mangano, D. T. (1996). Echocardiography for Assessing Cardiac Risk in Patients Having Noncardiac Surgery. ANN INTERN MED 125: 433-441 [Abstract] [Full Text]  
• Karmy-Jones, R., Hamilton, A., Dzavik, V., Allegreto, M., Finegan, B. A., Koshal, A. (1995). Magnesium Sulfate Prophylaxis After Cardiac Operations. Ann. Thorac. Surg. 59: 502-507 [Abstract] [Full Text]  
• Rich, M. R., Murphy, J. G., Adams, J. E., Ladenson, J. H., Jaffe, A. S. (1994). Troponin I in the Diagnosis of Postoperative Myocardial Infarction. NEJM 331: 277-277 [Full Text]  
• (1994). CARDIAC TROPONIN I: A MARKER OF PERIOPERATIVE MI. JWatch General 1994: 3-3 [Full Text]  
• Goldman, L. (1994). Assessment of Perioperative Cardiac Risk. NEJM 330: 707-709 [Full Text]