Department of Cardiovascular Surgery, Shiga University of Medical Science, Setatsukinowa, Otsu, Shiga, 520-2192, Japan.
J Cardiothorac Surg. 2022 Jul 6;17(1):169. doi: 10.1186/s13019-022-01924-5.
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.
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.
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).
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.
急性A型主动脉夹层（ATAAD）是一种致命的疾病，需要紧急手术。特别是当冠状动脉受累时，死亡率很高。然而，冠状动脉受累（ACI）的心肌损伤程度不同，可能会或可能不会增加肌酸激酶同工酶（CK-MB）。目前尚不清楚 CK-MB 升高如何影响手术结果。本研究比较了 CK-MB 升高和不升高的 ACI 两组的手术结果。
在 348 例接受急性 A 型主动脉夹层急诊手术的患者中，有 28 例（8.0%）患者并发 ACI，并接受了额外的冠状动脉旁路移植术。我们将其中 26 例患者分为两组：MI 组（CK-MB 升高）和 NMI 组（CK-MB 不升高），并对两组进行比较。
在这 26 例患者中，有 16 例在 MI 组，10 例在 NMI 组。MI 组 CK-MB 平均值为 225.5IU/L，NMI 组为 13.5IU/L。MI 组从发病到手术的平均时间为 248 分钟，NMI 组为 250 分钟。死亡率有统计学意义（69%比 13%，p=0.03）。两组在主要并发症（ICU 天数、再插管、再次手术、肺炎、败血症）方面无显著差异。
急性冠状动脉受累占 ATAAD 患者的 8.0%，62%的患者存在心肌缺血并伴有 CK-MB 升高。MI 组死亡率明显高于 NMI 组。对于疑似 ACI 的病例，尽快获得冠状动脉灌注以防止 CK-MB 升高至关重要。
