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Hadebe N, Cour M, Imamdin A, Petersen T, Pennel T, Scherman J, Snowball J, Ntsekhe M, Zilla P, Swanevelder J, Lecour S. Cardioprotection with Intralipid During Coronary Artery Bypass Grafting Surgery on Cardiopulmonary Bypass: A Randomized Clinical Trial. Cardiovasc Drugs Ther 2024:10.1007/s10557-024-07594-w. [PMID: 38864969 DOI: 10.1007/s10557-024-07594-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE Coronary artery bypass grafting (CABG) on cardiopulmonary bypass (CPB) is associated with myocardial ischemia-reperfusion injury (IRI), which may limit the benefit of the surgery. Both experimental and clinical studies suggest that Intralipid, a lipid emulsion commonly used for parenteral nutrition, can limit myocardial IRI. We therefore aimed to investigate whether Intralipid administered at reperfusion can reduce myocardial IRI in patients undergoing CABG on CPB. METHODS We conducted a randomized, double-blind, pilot trial in which 29 adult patients scheduled for CABG were randomly assigned (on a 1:1 basis) to receive either 1.5 ml/kg Intralipid 20% or Ringer's Lactate 3 min before aortic cross unclamping. The primary endpoint was the 72-h area under the curve (AUC) for troponin I. RESULTS Of the 29 patients randomized, 26 were included in the study (two withdrew consent and one was excluded before surgery). The 72-h AUC for troponin I did not significantly differ between the control and Intralipid group (546437 ± 205518 versus 487561 ± 115724 arbitrary units, respectively; P = 0.804). Other outcomes (including 72-h AUC for CK-MB, C-reactive protein, need for defibrillation, time to extubation, length of ICU and hospital stay, and serious adverse events) were similar between the two groups. CONCLUSION In patients undergoing CABG on CPB, Intralipid did not limit myocardial IRI compared to placebo. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02807727 (registration date: 16 June 2016).
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Affiliation(s)
- Nkanyiso Hadebe
- Cardioprotection Group, Faculty of Health Sciences, Cape Heart Institute, University of Cape Town, Anzio Road, Cape Town, 7925, Observatory, South Africa
- Department of Anaesthesia, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Martin Cour
- Cardioprotection Group, Faculty of Health Sciences, Cape Heart Institute, University of Cape Town, Anzio Road, Cape Town, 7925, Observatory, South Africa
| | - Aqeela Imamdin
- Cardioprotection Group, Faculty of Health Sciences, Cape Heart Institute, University of Cape Town, Anzio Road, Cape Town, 7925, Observatory, South Africa
| | - Tarra Petersen
- Cardioprotection Group, Faculty of Health Sciences, Cape Heart Institute, University of Cape Town, Anzio Road, Cape Town, 7925, Observatory, South Africa
| | - Timothy Pennel
- Chris Barnard Division of Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa
| | - Jacques Scherman
- Chris Barnard Division of Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa
| | - Jane Snowball
- Cardioprotection Group, Faculty of Health Sciences, Cape Heart Institute, University of Cape Town, Anzio Road, Cape Town, 7925, Observatory, South Africa
| | - Mpiko Ntsekhe
- Division of Cardiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Peter Zilla
- Chris Barnard Division of Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa
| | - Justiaan Swanevelder
- Department of Anaesthesia, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sandrine Lecour
- Cardioprotection Group, Faculty of Health Sciences, Cape Heart Institute, University of Cape Town, Anzio Road, Cape Town, 7925, Observatory, South Africa.
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Denessen EJ, Heuts S, Daemen JH, van Doorn WP, Vroemen WH, Sels JW, Segers P, Van‘t Hof AW, Maessen JG, Bekers O, Van Der Horst IC, Mingels AM. High-Sensitivity Cardiac Troponin I and T Kinetics Differ following Coronary Bypass Surgery: A Systematic Review and Meta-Analysis. Clin Chem 2022; 68:1564-1575. [DOI: 10.1093/clinchem/hvac152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Cardiac troponin I and T are both used for diagnosing myocardial infarction (MI) after coronary artery bypass grafting (CABG), also known as type 5 MI (MI-5). Different MI-5 definitions have been formulated, using multiples of the 99th percentile upper reference limit (10×, 35×, or 70× URL), with or without supporting evidence. These definitions are arbitrarily chosen based on conventional assays and do not differentiate between troponin I and T. We therefore investigated the kinetics of high-sensitivity cardiac troponin I (hs-cTnI) and T (hs-cTnT) following CABG.
Methods
A systematic search was applied to MEDLINE and EMBASE databases including the search terms “coronary artery bypass grafting” AND “high-sensitivity cardiac troponin.” Studies reporting hs-cTnI or hs-cTnT on at least 2 different time points were included. Troponin concentrations were extracted and normalized to the assay-specific URL.
Results
For hs-cTnI and hs-cTnT, 17 (n = 1661 patients) and 15 studies (n = 2646 patients) were included, respectively. Preoperative hs-cTnI was 6.1× URL (95% confidence intervals: 4.9–7.2) and hs-cTnT 1.2× URL (0.9–1.4). Mean peak was reached 6–8 h postoperatively (126× URL, 99–153 and 45× URL, 29–61, respectively). Subanalysis of hs-cTnI illustrated assay-specific peak heights and kinetics, while subanalysis of surgical strategies revealed 3-fold higher hs-cTnI than hs-cTnT for on-pump CABG and 5-fold for off-pump CABG.
Conclusion
Postoperative hs-cTnI and hs-cTnT following CABG surpass most current diagnostic cutoff values. hs-cTnI was almost 3-fold higher than hs-cTnT, and appeared to be highly dependent on the assay used and surgical strategy. There is a need for assay-specific hs-cTnI and hs-cTnT cutoff values for accurate, timely identification of MI-5.
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Affiliation(s)
- Ellen J Denessen
- Central Diagnostic Laboratory, Maastricht University Medical Center+ , Maastricht , the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , the Netherlands
| | - Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ , Maastricht , the Netherlands
| | - Jean H Daemen
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center , Heerlen , the Netherlands
| | - William P van Doorn
- Central Diagnostic Laboratory, Maastricht University Medical Center+ , Maastricht , the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , the Netherlands
| | - Wim H Vroemen
- Central Diagnostic Laboratory, Maastricht University Medical Center+ , Maastricht , the Netherlands
| | - Jan-Willem Sels
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , the Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Center+ , Maastricht , the Netherlands
- Department of Cardiology, Maastricht University Medical Center+ , Maastricht , the Netherlands
| | - Patrique Segers
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ , Maastricht , the Netherlands
| | - Arnoud W Van‘t Hof
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , the Netherlands
- Department of Cardiology, Maastricht University Medical Center+ , Maastricht , the Netherlands
- Department of Cardiology, Zuyderland Medical Center , Heerlen , the Netherlands
| | - Jos G Maessen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , the Netherlands
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ , Maastricht , the Netherlands
| | - Otto Bekers
- Central Diagnostic Laboratory, Maastricht University Medical Center+ , Maastricht , the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , the Netherlands
| | - Iwan C Van Der Horst
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , the Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Center+ , Maastricht , the Netherlands
| | - Alma M Mingels
- Central Diagnostic Laboratory, Maastricht University Medical Center+ , Maastricht , the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , the Netherlands
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Heuts S, Denessen EJ, Daemen JH, Vroemen WH, Sels JW, Segers P, Bekers O, van ‘t Hof AW, Maessen JG, van der Horst IC, Mingels AM. Meta-Analysis Evaluating High-Sensitivity Cardiac Troponin T Kinetics after Coronary Artery Bypass Grafting in Relation to the Current Definitions of Myocardial Infarction. Am J Cardiol 2022; 163:25-31. [PMID: 34763830 DOI: 10.1016/j.amjcard.2021.09.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/07/2021] [Accepted: 09/17/2021] [Indexed: 12/29/2022]
Abstract
Various definitions of myocardial infarction type 5 after coronary artery bypass grafting (CABG) have been proposed (myocardial infarction [MI-5], also known as peri-procedural MI), using different biomarkers and different and arbitrary cut-off values. This meta-analysis aims to determine the expected release of high-sensitivity cardiac troponin T (hs-cTnT) after CABG in general and after uncomplicated surgery and off-pump CABG in particular. A systematic search was applied to 3 databases. Studies on CABG as a single intervention and reporting on postoperative hs-cTnT concentrations on at least 2 different time points were included. All data on hs-cTnT concentrations were extracted, and mean concentrations at various points in time were stratified. Eventually, 15 studies were included, encompassing 2,646 patients. Preoperative hs-cTnT was 17 ng/L (95% confidence interval [CI] 13 to 20 ng/L). Hs-cTnT peaked at 6 to 8 hours postoperatively (628 ng/L, 95% CI 400 to 856 ng/L; 45x upper reference limit [URL]) and was still increased after 48 hours. In addition, peak hs-cTnT concentration was 614 ng/L (95% CI 282 to 947 ng/L) in patients with a definite uncomplicated postoperative course (i.e., without MI). For patients after off-pump CABG compared to on-pump CABG, the mean peak hs-cTnT concentration was 186 ng/L (95% CI 172 to 200 ng/L, 13 × URL) versus 629 ng/L (95% CI 529 to 726 ng/L, 45 × URL), respectively. In conclusion, postoperative hs-cTnT concentrations surpass most of the currently defined cut-off values for MI-5, even in perceived uncomplicated surgery, suggesting thorough reassessment. Hs-cTnT release differences following on-pump CABG versus off-pump CABG were observed, implying the need for different cut-off values for different surgical strategies.
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