Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
J Korean Med Sci. 2011 Aug;26(8):1041-6. doi: 10.3346/jkms.2011.26.8.1041. Epub 2011 Jul 27.
We performed a prospective cohort trial on 220 patients undergoing elective off-pump coronary artery bypass surgery and taking aspirin to evaluate the effect of aspirin resistance on myocardial injury. The patients were divided into aspirin responders and aspirin non-responders by the value of the aspirin reaction units obtained preoperatively using the VerifyNow™ Aspirin Assay. The serum levels of troponin I were measured before surgery and 1, 6, 24, 48 and 72 hr after surgery. In-hospital major adverse cardiac and cerebrovascular events, graft occlusion, the postoperative blood loss and reexploration for bleeding were recorded. Of the 220 patients, 181 aspirin responders (82.3%) and 39 aspirin non-responders (17.7%) were defined. There were no significant differences in troponin I levels (ng/mL) between aspirin responders and aspirin non-responders: preoperative (0.04 ± 0.08 vs 0.03 ± 0.06; P = 0.56), postoperative 1 hr (0.72 ± 0.87 vs 0.86 ± 1.10; P = 0.54), 6 hr (2.92 ± 8.76 vs 1.50 ± 2.40; P = 0.94), 24 hr (4.16 ± 13.44 vs 1.25 ± 1.95; P = 0.52), 48 hr (2.15 ± 7.06 vs 0.65 ± 0.95; P = 0.64) and 72 hr (1.20 ± 4.63 vs 0.38 ± 0.56; P = 0.47). Moreover, no significant differences were observed with regard to in-hospital outcomes. In conclusion, preoperative aspirin resistance does not increase myocardial injury in patients undergoing off-pump coronary artery bypass surgery. Postoperative dual antiplatelet therapy might have protected aspirin resistant patients.
我们对 220 例行择期不停跳冠状动脉旁路移植术并服用阿司匹林的患者进行了前瞻性队列研究，以评估阿司匹林抵抗对心肌损伤的影响。患者根据术前使用 VerifyNow™阿司匹林测定法获得的阿司匹林反应单位值分为阿司匹林反应者和阿司匹林无反应者。分别于术前、术后 1、6、24、48 和 72 小时测量肌钙蛋白 I 血清水平。记录住院期间主要心脏和脑血管不良事件、移植物闭塞、术后失血和再次探查出血。220 例患者中，181 例（82.3%）为阿司匹林反应者，39 例（17.7%）为阿司匹林无反应者。阿司匹林反应者和阿司匹林无反应者的肌钙蛋白 I 水平（ng/ml）无显著差异：术前（0.04±0.08 vs 0.03±0.06；P=0.56）、术后 1 小时（0.72±0.87 vs 0.86±1.10；P=0.54）、6 小时（2.92±8.76 vs 1.50±2.40；P=0.94）、24 小时（4.16±13.44 vs 1.25±1.95；P=0.52）、48 小时（2.15±7.06 vs 0.65±0.95；P=0.64）和 72 小时（1.20±4.63 vs 0.38±0.56；P=0.47）。此外，住院期间结局也无显著差异。结论：术前阿司匹林抵抗不会增加非体外循环冠状动脉旁路移植术后患者的心肌损伤。术后双联抗血小板治疗可能保护了阿司匹林抵抗患者。
