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The impact of CK-MB elevation in patients with acute type A aortic dissection with coronary artery involvement
Naoshi Minamidate1, Noriyuki Takashima1, Tomoaki Suzuki2
1Department of Cardiovascular Surgery, Shiga University of Medical Science, Setatsukinowa, Otsu, Shiga, 520-2192, Japan.
Insights
Acute type A aortic dissection with coronary artery involvement has high mortality. Elevated creatine kinase-MB (CK-MB) in these patients indicates myocardial ischemia and significantly increases surgical mortality risk.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Diseases
Background:
- Acute type A aortic dissection (ATAAD) is a life-threatening condition necessitating emergency surgery.
- Coronary artery involvement in ATAAD is associated with increased mortality.
- The impact of creatine kinase muscle and brain isoenzyme (CK-MB) elevation on surgical outcomes in ATAAD with coronary artery involvement remains unclear.
Purpose of the Study:
- To compare surgical outcomes between patients with acute type A aortic dissection and coronary artery involvement, stratified by the presence or absence of CK-MB elevation.
- To determine if CK-MB elevation in acute coronary artery involvement (ACI) affects mortality and major complications.
Main Methods:
- Retrospective analysis of 26 patients with ATAAD and coronary artery bypass grafting due to ACI.
- Patients were divided into two groups: MI group (with CK-MB elevation) and NMI group (without CK-MB elevation).
- Comparison of mortality and major postoperative complications between the MI and NMI groups.
Main Results:
- Sixteen patients were in the MI group and ten in the NMI group.
- The MI group exhibited significantly higher mortality (69% vs. 13%, p=0.03) compared to the NMI group.
- No significant differences were observed in major complications such as ICU days, reintubation, reoperation, pneumonia, or sepsis.
Conclusions:
- Acute coronary artery involvement occurs in 8.0% of ATAAD patients, with 62% showing myocardial ischemia indicated by CK-MB elevation.
- Elevated CK-MB in ACI is a significant predictor of increased mortality in ATAAD surgery.
- Prompt coronary perfusion is critical in suspected ACI cases to prevent CK-MB elevation and improve surgical outcomes.
Background:
Acute type A aortic dissection (ATAAD) is a fatal disease and requires emergency surgery. In particular, it is known that mortality is high when a coronary artery is involved. However, the degree of myocardial damage of the coronary acute artery involvement (ACI) varies and may or may not increase creatine kinase muscle and brain isoenzyme (CK-MB). It is unknown how CK-MB elevation affects the surgical outcome. This study compared the surgical results between the two groups of ACI with or without CK-MB elevation.
Methods:
Among 348 patients who underwent an emergency operation for acute type A aortic dissection, there were 28 (8.0%) patients complicated by ACI and underwent additional coronary artery bypass grafting. We divided 26 of those patients into two groups; the MI group ( with CK-MB elevation) and the NMI group (without CK-MB elevation), and compared both groups.
Results:
Of the 26, sixteen were in the MI group, and ten were in the NMI group. The average CK-MB in the MI group was 225.5 IU/L, and that in the NMI group was 13.5 IU/L. The mean time from onset to surgery was 248 min in the MI group and 250 min in the NMI group. There was statistical significance in mortality ( 69% vs. 13%, p = 0.03). There was no significance in major complications (ICU days, reintubation, reoperation, pneumonia, sepsis).
Conclusions:
Acute coronary artery involvement was associated with 8.0% of patients with ATAAD, and 62% had myocardial ischemia with CK-MB elevation. The MI group had significantly higher mortality than the NMI group. It is crucial for cases with suspected ACI to obtain coronary perfusion as soon as possible to prevent CK-MB from elevating.
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