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Ischaemic preconditioning reduces troponin T release in patients undergoing coronary artery bypass surgery
D P Jenkins1, W B Pugsley, A M Alkhulaifi
1University College London Hospital, University College Hospital, United Kingdom.
Insights
Ischaemic preconditioning significantly reduced myocardial injury in patients undergoing coronary artery bypass surgery. This protective effect against myocyte damage was demonstrated by lower troponin T levels in the preconditioned group.
Area of Science:
- Cardiology
- Cardiac Surgery
- Ischemic Physiology
Background:
- Myocardial injury is a significant concern in patients undergoing coronary artery bypass surgery (CABG).
- Troponin T release is a key biomarker for assessing myocardial damage.
- Investigating protective strategies against perioperative cardiac injury is crucial.
Purpose of the Study:
- To evaluate the efficacy of ischaemic preconditioning in reducing myocardial injury.
- To assess troponin T release as a marker of myocardial damage in patients undergoing elective CABG.
Main Methods:
- A randomised controlled trial was conducted in a cardiothoracic unit.
- 33 patients with three-vessel coronary artery disease were randomized into control or preconditioning groups.
- The preconditioning group received two 3-minute periods of myocardial ischaemia before bypass.
Main Results:
- All patients exhibited elevated troponin T postoperatively.
- Serum troponin T levels at 72 hours were significantly lower in the preconditioned group (median 0.3 µg/l) compared to the control group (median 1.4 µg/l).
- The difference in troponin T levels was statistically significant (P = 0.05).
Conclusions:
- Ischaemic preconditioning demonstrated a protective effect against irreversible myocyte injury in patients undergoing CABG.
- This study provides the first clinical evidence for the direct application of a preconditioning stimulus in surgical practice.
- Preconditioning may be a viable strategy to mitigate cardiac damage during cardiac surgery.
Objective:
To investigate whether ischaemic preconditioning could reduce myocardial injury, as manifest by troponin T release, in patients undergoing elective coronary artery bypass surgery.
Design:
Randomised controlled trial.
Setting:
Cardiothoracic unit of a tertiary care centre.
Patients:
Patients with three vessel coronary artery disease and stable angina admitted for first time elective coronary artery bypass surgery were invited to take part in the study; 33 patients were randomised into control or preconditioning groups.
Intervention:
Patients in the preconditioning group were exposed to two additional three minute periods of myocardial ischaemia at the beginning of the revascularisation operation, before the ischaemic period used for the first coronary artery bypass graft distal anastomosis.
Main Outcome Measure:
Serum troponin T concentration at 72 hours after cardiopulmonary bypass.
Results:
The troponin T assays were performed by blinded observers at a different hospital. All patients had undetectable serum troponin T (< 0.1 microgram/l) before cardiopulmonary bypass, and troponin T was raised postoperatively in all patients. At 72 hours, serum troponin T was lower (P = 0.05) in the preconditioned group (median 0.3 microgram/l) than in the control group (median 1.4 micrograms/l).
Conclusions:
The direct application of a preconditioning stimulus in clinical practice has been shown, for the first time, to protect patients against irreversible myocyte injury.