Kardioprotektivni efekat udaljenog ishemijskog prekondicioniranja tokom hirurške revaskularizacije miokarda u akutnom koronarnom sindromu bez ST elevacije
Cardioprotective effect of remote ischemic preconditioning during surgical revascularization in acute coronary syndrome without ST elevation.
Author
Miličić, MiroslavMentor
Milojević, PredragCommittee members
Soldatović, Ivan
Perić, Miodrag
Jović, Miomir

Romanović, Radoslav
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Show full item recordAbstract
Ranije studije su prikazale kontroverzne rezultate protektivnog dejstva udaljenog
ishemijskog prekondicioniranja (RICP) na ishemični miokard u različitim populacijama
bolesnika tokom kardiohirurških operacija. Cilj ovog rada je da prikaže efekte udaljenog
ishemijskog prekondicioniranja na rane rezultate hirurške revaskularizacije miokarda u
bolesnika sa akutnim koronarnim sindromom bez ST segment elevacije (NSTEMI AKS).
Metode: Ova studija obuhvatila je 60 bolesnika koji su randomizovani u dve grupe: Grupa
1 koja je tertirana sa RICP i Grupa 2 bez RICP (kontrolna grupa). Poređeni su pre, intra i
postoperativni klinički parametri ali je glavni cilj miokardna lezija koja se odražava kroz
vrednosti koncentracije Troponina I merenih preoperativno i 1, 6, 12, 24, 48 i 72h
postoperativno. Sekundarni ciljevi su bili hemodinamski parametri, krvarenje, vreme
lečenja u jedinici intenzivne nege i mortalitet.
Rezultati: Grupe 1 i 2 su bile slične po preoperativnim karakteristikama kao što su život...na
dob, NYHA klasa, EuroSCORE II, ejekciona frakcija leve komore i u zastupljenosti
trosudovne koronarne bolesti. Vreme kardiopulmonalnog bajpasa (86.90±29.60 vs 66.47
±20.90, p=0.003), vreme klemovanja aorte (57.50±18.32 vs 46.37±14.78, p=0.012) i broj
graftova (3.5(3-4) vs 2,83(2-3), p<0.001) bili su različiti. Ostale intra i postoperativne
varijable se nisu razlikovale među grupama. Nije bilo razlike u vrednostima C reaktivnog
proteina (CRP) i postoperativnih hemodinamskih parametara. Vrednosti Troponina I su
ispitivane u sedam vremenskih intervala i nisu pokazale značajnu razliku među grupama
(preoperativno 0,61±1,45 vs 0,79±1,95; 1h 2,15±4,67 vs 1,14±1,33; 6h 4,59±6,36 vs
3,39±2,79; 12h 3,59±2,68 vs 3,87±3,65; 24h 2,94±3,02 vs 4,00±4,60; 48h 1,71±1,67 vs
2,13±2,32 i 72h postoperativno 1,18±1,40 vs 1,24±1,45). Takođe nije bilo značajne razlike
u pojavi neželjenih događaja, dužini trajanja bolničkog lečenja i mortalitetu među grupama.
Zaključak: Udaljeno ishemijsko prekondicioniranje tokom hirurške revaskularizacije
miokarda u akutnom korornarnom sindromu bez ST segment elevacije ne obezbeđuje bolju
protekciju miokarda i hemodinamske kararkteristike ali su neophodne veće randomizovane
studije da bi se dokazao pravi efekat RICP.
Previous studies have shown controversial results of the protective effect of
remote ischemic preconditioning (RICP) on ischemic myocardium in different patient
populations during cardiac surgery. The aim of this study was to assess effects of remote
ischemic preconditioning on early outcomes in patients undergoing coronary bypass
surgery (CABG) following acute coronary syndrome without persistent ST segment
elevation (NSTEMI ACS).
Methods: This trial included 60 patients randomized into two groups: Group 1 received
RICP and Group 2 had no RICP (control group). Pre, intra and postoperative clinical
parameters were compared but primary endpoint was myocardial injury reflected as the
value of Troponin I (cTnI) measured preoperatively and 1, 6, 12, 24, 48 and 72h
postoperatively. The secondary endpoints were hemodynamic parameters, blood loss,
intensive care unit (ICU) stay and mortality.
Results: Groups 1 and 2 were similar regarding preoperative characteristics including age,
NYHA class..., EuroSCORE II, left ventricular ejection fraction and the presence of triple
vessel coronary disease. Cardiopulmonary bypass time (86.90±29.60 vs 66.47±20.90,
p=0.003), cross clamp time (57.50±18.32 vs 46.37±14.78, p=0.012) and number of
conduits (3.5(3-4) vs 2.83(2-3), p<0.001) were different. Other intra and postoperative
variables did not differ between groups. There were no differences in C reactive protein
(CRP) levels and postoperative hemodynamic parameters. Troponin values were examined
at seven time points and revealed no significant differences between groups (preoperatively
0,61±1,45 vs 0,79±1,95; 1h 2,15±4,67 vs 1,14±1,33; 6h 4,59±6,36 vs 3,39±2,79; 12h
3,59±2,68 vs 3,87±3,65; 24h 2,94±3,02 vs 4,00±4,60; 48h 1,71±1,67 vs 2,13±2,32 and
72h postoperatively 1,18±1,40 vs 1,24±1,45). Furthermore, there were no significant
differences in adverse events, hospital stay and mortality between groups.
Conclusions: Treatment with RICP during CABG following NSTEMI ACS did not
provide better myocardial protection and hemodynamics characteristics but further larger
randomized studies are needed to prove its real value.