Year 2015 Vol. 23 No 2

GENERAL AND SPECIAL SURGERY

V.V. DOROFEYKOV, T.A. SHESHURINA, D.I. KURAPEEV, V.O. KABANOV, N.S. PASCAR, I.V. SUHOVA, A.V. VOROBYOVA, T.V. VAVILOVA, E.V. KULESHOVA

DYNAMICS OF TROPONIN I IN DIFFERENT TYPES OF CARDIAC SURGERY AND APPLICATION OF ESC/ACCF/AHA/WHF 2012 RECOMMENDATIONS IN DIAGNOSTICS OF POSTOPERATIVE MYOCARDIAL DAMAGE

FBSE "Federal Medical Research Center named after V.A. Almazov", Saint-Petersburg,
The Russian Federation

Objectives. To compare the degree of troponin I concentration elevation in patients after various cardiac surgeries. To assess the applicability of international ESC/ACCF/AHA/WHF 2012 recommendations for diagnostics of postoperative myocardial infarction (MI).
Methods. The patients were divided into three groups. In the first group the percutaneous coronary intervention (PCI) has been performed (n=112). In the second group the patients (n=62) were subjected to the isolated aorta-coronary bypass grafting (ACBG). In the third group (n=18) the combination of aorta-coronary bypass grafting with the left ventricular aneurysm plasty has been carried out. The measurement of serum concentrations of cardiac troponin before treatment and then 24 hours after the surgery.
Results. It is shown that the volume and nature of surgical intervention significantly affect the extent of myocardial damage, and also on the dynamics of postoperative troponin level. Exceeding the recommended ESC / ACCF / AHA / WHF diagnostic troponin level (99 percentile) for the diagnosis of myocardial infarction after percutaneous coronary intervention (PCI) 5-folds was observed in 26 (23,8%) patients, exceeding 10-folds in 13 (11,4%), exceeding 20-folds 4 (3,5%), in excess of 50-folds or more in 21 (18,8%) patients. After isolated coronary artery bypass grafting (ICABG) the diagnostic level of MI determination is equal to 10-folds exceeding of 99 percentile. In the group with ICABG 20-folds exceeding was observed in 1 (1,7%), 50-folds and more exceeding in 25 (40,3%), 100-folds and more exceeding in 36 (58%) patients. In the combined surgery a significant exceeding of the troponin concentration has ben noticed: exceeding of 99 percentile in 50-100-folds in 2 patients (11,2%), more than 100-folds exceeding in 16 (88,8%) patients.
Conclusion. Troponinemia while carrying out of the extended cardiac surgical procedures is not accompanied by the signs of myocardial ischemia has demonstrated in the most cases. Accepted criteria of the postoperative MI diagnostics require in reviewing and optimization to exclude cases of unjustified diagnostics of MI.

Keywords: myocardial infarction, myocardial ischemia, percutaneous coronary intervention, isolated coronary artery bypass grafting, myocardial revascularization, postoperative myocardial damage, cardiac troponin
p. 165-170 of the original issue
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Address for correspondence:
194156, Rossiyskaya Federatsiya,
g. Sankt-Peterburg, pr. Parhomenko, d. 15,
FBGU "Federalnyiy meditsinskiy
issledovatelskiy tsentr im. V.A. Almazova",
tel. mob.: 8 911 211-26-12,
e-mail: vdorofeykov@ya.ru,
Dorofeykov Vladimir Vladimirovich
Information about the authors:
Dorofeykov V.V. MD, professor of the clinical laboratory diagnostics and genetics chair of FBSE "Federal Medical Research Center named after V.A. Almazov", St. Petersburg.
Sheshurina T.A. A post-graduate student of FBSE "Federal Medical Research Center named after V.A. Almazov", St. Petersburg.
Kurapeev D.I. PhD, a head of SRL of bioprosthetics and cardioprotection of FBSE "Federal Medical Research Center named after V.A. Almazov", St. Petersburg.
Kabanov V.O. A post-graduate student of FBSE "Federal Medical Research Center named after V.A. Almazov", St. Petersburg.
Pascar N.S. A physician of FBSE "Federal Medical Research Center named after V.A. Almazov", St. Petersburg.
Suhova I.V. PhD, a physician of FBSE "Federal Medical Research Center named after V.A. Almazov", St. Petersburg.
Vorobyova A.V. A physician of FBSE "Federal Medical Research Center named after V.A. Almazov", St. Petersburg.
Vavilova T.V. MD, professor, a head of the clinical laboratory diagnostics and genetics chair of FBSE "Federal Medical Research Center named after V.A. Almazov", St. Petersburg.
Kuleshova E.V. MD, professor, freelancer researcher of FBSE "Federal Medical Research Center named after V.A. Almazov", St. Petersburg.
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