KAUSHIK A, @ All
AGARWAL S K,
047373 KAUSHIK A, @ All
AGARWAL S K,
(Cardiology Dep, Sanjay Gandhi PGIMS, Lucknow - ?226 014,
Uttar Pradesh, Email: email@example.com) : Statin reload before off - pump coronary artery bypass graft: Effect on
biomarker release kinetics
. Ann. Card. Anaesth 2020, 23 (1), 27 - 33.
Statins confer protection from ischemia/reperfusion through various pathways
including pleiotropic mechanisms. Following chronic administration, activation of intrinsic cellular
mechanisms causes attenuation of these pleiotropic effects. Since coronary artery
bypass surgery (CABG) represents a reversible ischemia - reperfusion sequence, we assessed if
statin reload is effective in patients undergoing off - pump CABG (n = 100) in limiting myocardial
injury. Patients received loading dose of rosuvastatin (40 mg initiated 7 days before surgery) while
nonloaded patients continued whatever statin dose they were receiving and served as controls.
Cardiac biomarkers (Troponin - I, creatine kinase muscle/brain [CK - MB], and B - type natriuretic
peptide [BNP]) were measured at 8, 24, and 48 h postoperatively. The primary end - point was the
extent of perioperative myocardial injury (area under the curve [AUC]: AUC of each biomarker).
Despite similar baseline levels, all biomarkers at 8, 24, and 48 h were significantly lower
in the loaded group. The AUC for each biomarker was also significantly lower in the loaded
group (cTnI 37.96 vs. 70.12 ng. hr/ml, CK - MB 229.64 vs. 347.04 ng. hr/ml, and BNP 5257.56 vs.
15606.68 pg. hr/ml, all P < 0.001). Delta cTnI (change from baseline to peak level) (1.00 ? 1.34
vs. 2.25 ? 2.59), delta CK - MB (4.54 ? 5.89 vs. 10.68 ? 9.95), and delta BNP (120.41 ? 172.48 vs.
449.23 ? 790.95) all P < 0.001 were also significantly lower in the loaded group. Those loaded with
rosuvastatin had lower inotrope duration (22.9 ? 23.33 vs. 31.26 ? 25.39 h, P = 0.04) and ventilator
support time (16.94 ? 6.78 vs. 23.8 ? 20.53 h, P = 0.03). In patients undergoing
off - pump CABG, statin reload can ?recapture? cardioprotection in patients already on statins with
favorable effect on release kinetics of biomarkers and postoperative outcomes.
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