Myocardial injury after off-pump coronary artery bypass grafting operation

Paparella, Domenico; Cappabianca, Giangiuseppe; Malvindi, Pietro Giorgio; Paramythiotis, Andreas; Galeone, Antonella; Veneziani, N.; Fondacone, Corrado; Schinosa, Luigi de Luca Tupputi

doi:10.1016/j.ejcts.2007.06.015

Cited by 24 publications

(11 citation statements)

References 28 publications

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“…Furthermore, the cTnI level may be used to predict the prognosis of patients and the occurrence of two-year post-surgical cardiac ischemic events (21–23). CK-MB is not a specific myocardial injury indicator, but it exhibits an identical function to cTnI when its concentration is >20 IU (2,24,25). Therefore, in the present study, cTnI and CK-MB were utilized as indicators in order to observe the impact of dexmedetomidine on myocardial injuries.…”

Section: Discussionmentioning

confidence: 99%

“…CTnI and CK-MB levels may therefore be indicative of the result of the surgery. The three-year survival rates of patients whose cTnI and CK-MB levels were above the threshold value have been demonstrated to be lower than those of patients with normal cTnI and CK-MB levels (2). With the development of fixation technology, the traditional surgical approach has gradually been replaced by off-pump coronary artery bypass (OPCAB) grafting (3).…”

Section: Introductionmentioning

confidence: 99%

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Protective effect of dexmedetomidine in coronary artery bypass grafting surgery

Ren

Zhang

Huang

et al. 2013

Experimental and Therapeutic Medicine

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The aim of this study was to observe the impact of dexmedetomidine on postoperative myocardial injury in patients undergoing off-pump coronary artery bypass (OPCAB) grafting. One hundred and sixty-two patients who were undergoing OPCAB surgery were randomly divided into control and dexmedetomidine groups (groups C and Dex, respectively). Following the first vascular anastomosis grafting, the patients in group Dex received a continuous intravenous infusion of 0.2–0.5 μg/kg/h dexmedetomidine, until they were transferred to the Cardiac Surgery intensive care unit (ICU) for 12 h. Patients in group C received physiological saline intraoperatively and an intravenous infusion of 2–4 mg/kg/h isopropylphenol for postoperative sedation. Invasive arterial pressure and heart rate were continuously monitored for 5 min subsequent to entry into the operating theatre (T0), immediately following surgery (T1), 12 h post-surgery (T2), 24 h post-surgery(T3), 48 h post-surgery(T4) and 72 h post-surgery (T5). Blood samples were taken to determine the plasma levels of cardiac troponin I (cTnI) and creatine kinase-MB (CK-MB) at each time point. At 72 h post-surgery, a dynamic electrocardiogram was monitored. The blood pressure, heart rate, levels of cTnI, CK-MB, norepinephrine and cortisol, and postoperative arrhythmic events in the patients in group Dex all decreased compared with those in group C. The duration of mechanical ventilation and ICU residence time were also shorter than those in the control group (P<0.05). Dexmedetomidine reduced post-surgical myocardial injury in patients who had undergone OPCAB surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Protective effect of dexmedetomidine in coronary artery bypass grafting surgery

Ren

Zhang

Huang

et al. 2013

Experimental and Therapeutic Medicine

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“…As compared to CK-MB that is not unique to the heart and is found in skeletal muscle and the gastrointestinal tract and can form complexes with circulating immunoglobulins, TnI and TnT are unique to the cardiac myofibril's contractile apparatus, have a higher percentage released into the bloodstream after cardiac injury, do not form immunoglobulin complexes, and display a superior persistence in the bloodstream owing to the slow release and slow degradation with a half-life of about 2 h, allowing for improved clinical detection after a cardiac event [31]. On this basis, the troponins (TnT, TnI) have been shown to be better predictors of post-CABG mortality than CK-MB; clinical studies comparing CK-MB with TnI and TnT have demonstrated that troponins are superior predictors of post-CABG mortality [32,33,34]. …”

Section: Discussionmentioning

confidence: 99%

The Effectiveness of Preoperative Trimetazidine on Myocardial Preservation in Coronary Artery Bypass Graft Patients: A Systematic Review and Meta-Analysis

Zhang¹,

Lei

Liu

et al. 2015

Cardiology

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Background: Coronary artery bypass grafting (CABG) is a key and effective surgical treatment modality for coronary artery disease. Unfortunately, ischemia-reperfusion injury during and after CABG can lead to reversible and irreversible myocardial damage. Trimetazidine [1-(2,3,4-trimethoxybenzyl)piperazine dihydrochloride] is a metabolic anti-ischemic agent with demonstrated cardioprotective effects; however, its effects with respect to myocardial preservation in CABG patients remain unclear. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to investigate the effectiveness of myocardial preservation of preoperative trimetazidine therapy in CABG patients by assessing the postoperative levels of several blood-based biochemical markers of myocardial injury, including creatine kinase (CK), creatine kinase-muscle and brain (CK-MB), creatine phosphokinase (CPK), troponin T (TnT) and troponin I (TnI). The RCTs were classified into two subgroup analyses by the timing of sample collection (either ≤12 or >12 h after CABG). Results: Six RCTs were finally included in the meta-analysis. The pooled effect sizes showed significantly lower postoperative levels of CK, CK-MB, TnT and TnI in the trimetazidine-treated CABG patients relative to control CABG patients. However, there were no significant differences in the postoperative CPK levels between trimetazidine-treated CABG patients relative to control CABG patients. In both the ≤12 and >12 h post-CABG subgroup analyses, significant differences in CK, CK-MB, TnT and TnI were detected between the trimetazidine-treated CABG patients relative to control CABG patients. Conclusions: Preoperative trimetazidine therapy appears to have a positive effect on myocardial preservation in CABG patients.

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“…As the risk of postoperative myocardial infarction increases with the total load and duration of the ischaemic events [1], it is of importance to detect ischaemia early, and, if possible, to correct the underlying cause. Myocardial damage as measured by release of cardiac enzymes in the postoperative period also predicts higher 1-and 3-year mortality [2]. Conventional techniques as electrocardiographic (ECG) or haemodynamic monitoring are used in the postoperative setting to detect myocardial ischaemia early.…”

Section: Introductionmentioning

confidence: 99%