Perioperative myocardial infarction may be underdiagnosed and/or misdiagnosed because World Health Organization criteria are often not met and creatinine kinase/creatinine kinase-muscle band (CK/CK-MB) ratios can be difficult to interpret. Cardiac troponin (cTn) I is the most sensitive and specific marker of myocardial cell necrosis but is not yet widely available. The aim was to compare cTnI and CK/CK-MB ratios in the diagnosis of myocardial infarction following aortic surgery.


This prospective study included 58 patients undergoing elective (27 aneurysm, seven occlusive) or emergency (24 ruptured aneurysms) aortic surgery. cTnI concentration was measured before operation and 6, 24, 48, 72 and 96 h after surgery. CK and CK-MB levels were measured where cTnI was detectable. Clinical and electrocardiographically detected cardiac events were documented prospectively.


 Emergency (n = 24)Elective (n = 34)
cTnI rise > 0·5 ng ml−1139
CK/CK-MB rise (ratio > 5%) where cTnI detected40
cTnI rise and cardiac event84
cTnI rise with no cardiac event55


More than half of patients undergoing emergency, and more than a quarter of those undergoing elective, aortic surgery suffer myocardial necrosis as determined by cTnI concentration. This is accompanied by an increased CK/CK-MB ratio in less than one-fifth of cases.