Akut miyokardiyal infarktüs sonrası bypass cerrahisinden önce troponin I seviyeleri: Ne zaman opere etmeli?

Yıl 2018, , 228 - 232, 01.09.2018

Mihriban Yalçın , Eda Gödekmerdan Katırcıoğlu Serkan Yazman Kaptanı Derya Tayfur , Melih Ürkmez

https://doi.org/10.28982/josam.416286

Cited By: 1

Öz

Amaç: Kardiyak troponin I'in (cTnI) preop ölçümü miyokard infarktüsü (MI) olan hastalarda cerrahi riskin belirleyicisi olabilir. Amacımız, son zamanlarda akut miyokard infarktüsü geçirmiş olan hastalarda nispeten stabil klinik koşullar altında kardiyak troponin I'in preoperatif serum düzeylerinin prognostik değerini açıklamaktır.

Yöntemler: Bu çalışma küçük bir devlet hastanesinde yapılmış retrospektif bir çalışmadır. Akut MI nedeniyle Ocak 2012 ile Aralık 2014 arasında ilk kez izole KABG geçiren 65 hasta alındı. Ameliyat öncesi cTnI ölçümleri için numuneler operasyondan önce günlük olarak toplandı. Hastalar, ST veya nonST MI geçirmiş ve erken izole KABG geçirmişlerse bu çalışmaya dahil edildi. KABG'den 24 saat önce cTnI serum seviyeleri ile postoperatif hasta sonuçları arasındaki ilişkiyi değerlendirdik.

Bulgular: Mortalite olan olgularda troponin yüksek olmasına rağmen istatistiksel olarak anlamlı değildi. Giriş troponin ve yoğun bakım ünitesinin (YBÜ) kalış süresi ve taburculuk süresi arasında anlamlı derecede zayıf bir korelasyon vardı. Troponin düzeyleri ile diğer postoperatif hastane içi hasta sonuçları arasında istatistiksel olarak anlamlı bir ilişki bulunmadı.

Sonuç: Troponin değerleri ile postoperatif veriler arasında anlamlı bir korelasyon olmamasına rağmen, troponin mortalite olanlarda olmayanlara göre daha yüksekti. Bu nedenle, KABG'ye girmeye hazırlanan AMI hastaları için yaşamsal belirtiler stabil ise, troponinin neredeyse normal değerlere düşmesine kadar ameliyatın ertelenmesi gerektiğini öneriyoruz.

Anahtar Kelimeler

Akut miyokard infarktüsü, Koroner arter baypas cerrahisi, Troponin I

Troponin I levels before bypass surgery after acute myocardial infarction; When to operate?

Öz

Aim: Measurement of cardiac troponin I (cTnI) preop coronary artery bypass surgery (CABG) may be a determinant of surgical risk in patients with myocardial infarction (MI). Our aim is to explain the prognostic value of the preoperative serum levels of cardiac troponin I in patients with a recent acute MI under relatively stable clinical conditions.

Methods: This study was a retrospective single-center study in a small state hospital in Turkey. Included were 65 patients that had undergone a first-time isolated CABG between January 2012 and December 2014 due to acute MI. Samples for preoperative cTnI measurements were collected daily prior to the operation. Patients were enrolled in this study if they had nonST or ST elevation MI and had also undergone an early isolated CABG. We evaluated the association between serum levels of cTnI 24 hours before CABG and postoperative in-hospital patient outcomes.

Results: In cases with mortality troponin was high but it was not statistically significant. There was a significant poor positive correlation between admission troponin and intensive care unit (ICU) stay and the duration of discharge. No statically significant correlation was found between troponin levels and other postoperative in- hospital patient outcomes.

Conclusion: Although there was no significant correlation between troponin values and postoperative data troponin was higher than those without mortality. Therefore we suggest that if the vital signs are stable for patients with AMI preparing to undergo CABG, surgery should be delayed until troponin falls to nearly normal values.

Anahtar Kelimeler

Acute myocardial infarction, Coronary artery bypass surgery, Troponin I

Kaynakça

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