冠心病患者在择期下肢手术中的围手术期心肌损伤

IF 0.3 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Rational Pharmacotherapy in Cardiology Pub Date : 2023-10-10 DOI:10.20996/1819-6446-2023-2937
Y. Kudaev, A. V. Vorobeva, N. L. Lokhovinina, I. T. Abesadze, M. Z. Alugishvili, I. V. Titenkov, M. A. Chernyavsky, A. Panov
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In the postoperative period, the incidence of myocardial injury was assessed by hs-cTn increase. The obtained primary data were subjected to mathematical processing using the R-Studio software package (R language).Results. At baseline, patients in both groups were comparable in clinical characteristics, therapy, and duration of vascular surgery. In the main group of patients receiving nicorandil, a significant decrease in the incidence of perioperative myocardial injury was noted. In 5 patients of the control group, hs-cTn level 24 hours after surgery exceeded the threshold value, which indicated myocardial injury in the early postoperative period. In the nicorandil group, there was no hs-cTn increase (14% vs 0%, p=0,027). Regression analysis identified a predictor of perioperative myocardial injury — left ventricular ejection fraction (LVEF) <50%. LVEF <50% increases the risk of myocardial injury in the early postoperative period by 7,36 times (p=0,04) and 9,15 times (p=0,048) according to univariate and multivariate regression analysis, respectively.Conclusion. Perioperative myocardial injury is a common complication in patients with CAD undergoing lower extremity revascularization. The use of nicorandil (Cordinic, PIQ-PHARMA) before elective revascularization surgery helps reduce the incidence of ischemic myocardial injury in the early postoperative period and is not accompanied by adverse reactions, which rationales this approach to improve the clinical outcomes of lower extremity revascularization in patients with stable CAD. 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引用次数: 0

摘要

目的通过评估择期下肢手术中稳定型冠状动脉疾病(CAD)患者的高敏心肌肌钙蛋白(hs-cTn),评估缺血性心肌损伤的发生率和尼可地尔的心脏保护作用,并确定不良心脏事件的预测因素。研究对象包括70名住院接受择期自体股腘旁路(FPB)手术的稳定型冠心病患者。随机分组后,所有患者被分为以下两组:对照组--35 名患者;主治组--35 名患者,除标准治疗外,还在手术前 2 小时服用尼可地尔(Cordinic,PIQ-PHARMA),单次剂量为 20 毫克。术后通过 hs-cTn 升高评估心肌损伤的发生率。使用 R-Studio 软件包(R 语言)对获得的主要数据进行数学处理。基线时,两组患者的临床特征、治疗方法和血管手术时间相当。在接受尼可地尔治疗的主要组患者中,围手术期心肌损伤的发生率显著下降。对照组中有 5 名患者术后 24 小时的 hs-cTn 水平超过了阈值,这表明术后早期出现了心肌损伤。尼可地尔组的 hs-cTn 没有增加(14% 对 0%,P=0,027)。回归分析确定了围手术期心肌损伤的预测因素--左心室射血分数(LVEF)<50%。根据单变量和多变量回归分析,LVEF <50%会使术后早期心肌损伤的风险分别增加7.36倍(P=0.04)和9.15倍(P=0.048)。围手术期心肌损伤是接受下肢血管重建术的 CAD 患者的常见并发症。在选择性血管重建手术前使用尼可地尔(Cordinic,PIQ-PHARMA)有助于降低术后早期缺血性心肌损伤的发生率,且不会伴有不良反应,因此这种方法可以改善稳定型 CAD 患者下肢血管重建手术的临床效果。通过 hs-cTn 确定的心肌损伤预测指标是 LVEF <50%。
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Perioperative myocardial injury in patients with coronary artery disease during elective lower limb surgery
Aim. To assess the prevalence of ischemic myocardial injury and the cardioprotective effect of nicorandil by assessing high-sensitivity cardiac troponin (hs-cTn) in patients with stable coronary artery disease (CAD) during elective lower limb surgery, as well as to identify predictors of adverse cardiac events.Material and methods. The study included 70 patients with stable coronary artery disease hospitalized for elective autogenous femoropopliteal bypass (FPB) surgery. After randomization, all patients were divided into two following groups: control group — 35 patients; main group — 35 patients, who, in addition to standard therapy, were prescribed nicorandil (Cordinic, PIQ-PHARMA) in a single dose of 20 mg 2 hours before surgery. In the postoperative period, the incidence of myocardial injury was assessed by hs-cTn increase. The obtained primary data were subjected to mathematical processing using the R-Studio software package (R language).Results. At baseline, patients in both groups were comparable in clinical characteristics, therapy, and duration of vascular surgery. In the main group of patients receiving nicorandil, a significant decrease in the incidence of perioperative myocardial injury was noted. In 5 patients of the control group, hs-cTn level 24 hours after surgery exceeded the threshold value, which indicated myocardial injury in the early postoperative period. In the nicorandil group, there was no hs-cTn increase (14% vs 0%, p=0,027). Regression analysis identified a predictor of perioperative myocardial injury — left ventricular ejection fraction (LVEF) <50%. LVEF <50% increases the risk of myocardial injury in the early postoperative period by 7,36 times (p=0,04) and 9,15 times (p=0,048) according to univariate and multivariate regression analysis, respectively.Conclusion. Perioperative myocardial injury is a common complication in patients with CAD undergoing lower extremity revascularization. The use of nicorandil (Cordinic, PIQ-PHARMA) before elective revascularization surgery helps reduce the incidence of ischemic myocardial injury in the early postoperative period and is not accompanied by adverse reactions, which rationales this approach to improve the clinical outcomes of lower extremity revascularization in patients with stable CAD. A predictor of myocardial injury, determined by hs-cTn, is a LVEF <50%.
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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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