Incidence and Severity of Acute Myocardial Injury after Thoracic Surgery: Effects of Nicorandil

IF 0.3 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Rational Pharmacotherapy in Cardiology Pub Date : 2023-03-07 DOI:10.20996/1819-6446-2023-01-08
K. Protasov, O. A. Barahtenko, E. Batunova, E. A. Rasputina
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Abstract

Aim. To study the perioperative dynamics of myocardial injury biomarkers high-sensitivity cardiac troponin I (hs-cTnI), ischemia-modified albumin (IMA) and soluble ST2 (sST2) when taking nicorandil in lung cancer patients with concomitant coronary heart disease (CHD) undergoing surgical lung resection.Material and methods. The study included 54 patients (11 women and 43 men) with non-small cell lung cancer and concomitant stable CHD who underwent lung resection in the volume of lobectomy or pneumonectomy. Patients were randomly assigned to the nicorandil group (oral administration 10 mg BID for 7 days before and 3 days after surgery; n=27) and the control group (n=27). In the study groups, the perioperative dynamics of hscTnI, IMA and sST2, determined in the blood before and 24 and 48h after surgery, were compared. We calculated the incidence of acute myocardial injury in the groups, which was diagnosed in cases of postoperative hs-cTnI increase of more than one 99th percentile of the upper reference limit. The associations of nicorandil intake and acute myocardial injury were evaluated.Results. The groups were comparable in gender, age, basic clinical characteristics, as well as baseline levels of myocardial injury biomarkers. After the intervention, both samples showed an increase in the hs-cTnI and sST2 levels and a decrease in IMA concentration (all p<0.02 for related group differences). In the nicorandil group, in comparison with the control one, 48h after surgery, we found lower mean levels of hs-cTnI [16.7 (11.9;39.7) vs 44.3 (15.0;130.7) ng/l; p<0.05) and sST2 [62.8 (43.6;70.1) vs 76.5 (50.2;87.1) ng/ml; p<0.05), concentration increase rates of hs-cTnI [14.8 (0.7;42.2) vs 32.5 (14.0;125.0) ng/l; p<0.01) and sST2 [24.4 (10.3;42.4) vs 47.4 (17.5;65.3) ng/ml; p<0.05), as well as highest concentrations for the entire postoperative period of hs-cTnI [30.7 (12.0;53.7) vs 79.0 (20.3;203.3) ng/L, p<0.01] and sST2 [99.8 (73.6;162.5) vs 147.8 (87.8;207.7) ng/mL; p<0.05]. The serum IMA decreased when taking nicorandil to a greater extent [-8.0 (-12.6; -2.0) vs -2.7 (-6.0; +5.5) ng/ ml; p<0.01] 24h after surgery. Acute myocardial injury was diagnosed in 7 people in the nicorandil group (25.9%) and in 15 in the control one (55.6%; pχ2=0.027). The adjusted odds ratio of acute myocardial injury when taking nicorandil was 0.35 (95% confidence interval 0.15-0.83, p=0.017).Conclusion. Taking  nicorandil  in patients with lung cancer and concomitant CHD  who underwent  surgical  lung resection is associated  with a lower postoperative  increase in hs-cTnI  and sST2  and a reduced risk of acute myocardial  injury, which may indicate the cardioprotective effect of nicorandil under acute surgical stress conditions.
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胸外科术后急性心肌损伤的发生率和严重程度:尼可地尔的影响
的目标。研究肺癌合并冠心病(CHD)行肺切除术患者服用尼可地尔时心肌损伤生物标志物高敏心肌肌钙蛋白I (hs-cTnI)、缺血修饰白蛋白(IMA)和可溶性ST2 (sST2)围手术期的动态变化。材料和方法。该研究包括54例非小细胞肺癌合并稳定型冠心病患者(11名女性和43名男性),他们在肺叶切除术或全肺切除术中进行了肺切除术。患者随机分为尼可地尔组(术前7天和术后3天口服BID 10 mg;N =27)和对照组(N =27)。比较两组患者术前及术后24、48小时血液中hscTnI、IMA和sST2的围手术期动态。我们计算各组急性心肌损伤的发生率,术后hs-cTnI升高超过参考上限99个百分位的病例诊断为急性心肌损伤。评价尼可地尔摄入与急性心肌损伤的关系。两组在性别、年龄、基本临床特征以及心肌损伤生物标志物的基线水平上具有可比性。干预后,两组患者hs-cTnI和sST2水平均升高,IMA浓度下降(相关组差异均p<0.02)。在尼可地尔组,与对照组相比,术后48小时,我们发现hs-cTnI的平均水平较低[16.7 (11.9;39.7)vs 44.3 (15.0;130.7) ng/l;p<0.05)和sST2 [62.8 (43.6;70.1) vs 76.5 (50.2;87.1) ng/ml;p<0.05), hs-cTnI浓度增加率[14.8 (0.7;42.2)vs 32.5 (14.0;125.0) ng/l;p<0.01)和sST2 [24.4 (10.3;42.4) vs 47.4 (17.5;65.3) ng/ml;p<0.05),以及hs-cTnI在整个术后期间的最高浓度[30.7 (12.0;53.7)vs 79.0 (20.3;203.3) ng/L, p<0.01]和sST2 [99.8 (73.6;162.5) vs 147.8 (87.8;207.7) ng/mL;p < 0.05)。服用尼可地尔时血清IMA下降幅度更大[-8.0 (-12.6;-2.0) vs -2.7 (-6.0;+5.5) ng/ ml;P <0.01]术后24h。尼可地尔组确诊急性心肌损伤7例(25.9%),对照组确诊急性心肌损伤15例(55.6%);pχ2 = 0.027)。尼可地尔对急性心肌损伤的校正优势比为0.35(95%可信区间0.15 ~ 0.83,p=0.017)。肺癌合并冠心病行肺切除术患者服用尼可地尔,术后hs-cTnI和sST2升高较低,急性心肌损伤风险降低,可能提示尼可地尔在急性手术应激条件下具有心脏保护作用。
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来源期刊
Rational Pharmacotherapy in Cardiology
Rational Pharmacotherapy in Cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
1.00
自引率
50.00%
发文量
79
审稿时长
6 weeks
期刊介绍: The primary goals of the Journal are consolidation of information on scientific and practical achievements in pharmacotherapy and prevention of cardiovascular diseases and continuing education of cardiologists and internists. The scientific concept of the edition suggests the publication of information on current achievements in cardiology, the results of national and international clinical trials. The Journal publishes original articles on the results of clinical trials designed to study the effectiveness and safety of drugs, analysis of clinical practice and its compliance with national and international recommendations, expert s’ opinions on a wide range of cardiology issues, associated conditions and clinical pharmacology. There is a heading “Preventive cardiology and public health” in the Journal to stimulate research interest in this highly demanded area. Memories of the outstanding people in medicine including cardiology, which are of great interest to historians of medicine, are published in "Our Mentors” heading.
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