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Statin Reload before Off-pump Coronary Artery Bypass Graft: Effect on Biomarker Release Kinetics

OBJECTIVES: 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. METHODS: Since coronary artery bypass surgery (CAB...

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Autores principales: Kaushik, Atul, Kapoor, Aditya, Agarwal, Surendra K, Pande, Shantanu, Tewari, Prabhat, Majumdar, Gauranga, Sinha, Archana, Kashyap, Shiridhar, Khanna, Roopali, Kumar, Sudeep, Garg, Naveen, Tewari, Satyendra, Goel, Pravin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7034209/
https://www.ncbi.nlm.nih.gov/pubmed/31929243
http://dx.doi.org/10.4103/aca.ACA_133_18
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author Kaushik, Atul
Kapoor, Aditya
Agarwal, Surendra K
Pande, Shantanu
Tewari, Prabhat
Majumdar, Gauranga
Sinha, Archana
Kashyap, Shiridhar
Khanna, Roopali
Kumar, Sudeep
Garg, Naveen
Tewari, Satyendra
Goel, Pravin
author_facet Kaushik, Atul
Kapoor, Aditya
Agarwal, Surendra K
Pande, Shantanu
Tewari, Prabhat
Majumdar, Gauranga
Sinha, Archana
Kashyap, Shiridhar
Khanna, Roopali
Kumar, Sudeep
Garg, Naveen
Tewari, Satyendra
Goel, Pravin
author_sort Kaushik, Atul
collection PubMed
description OBJECTIVES: 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. METHODS: 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). RESULTS: 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). CONCLUSION: 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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spelling pubmed-70342092020-03-09 Statin Reload before Off-pump Coronary Artery Bypass Graft: Effect on Biomarker Release Kinetics Kaushik, Atul Kapoor, Aditya Agarwal, Surendra K Pande, Shantanu Tewari, Prabhat Majumdar, Gauranga Sinha, Archana Kashyap, Shiridhar Khanna, Roopali Kumar, Sudeep Garg, Naveen Tewari, Satyendra Goel, Pravin Ann Card Anaesth Original Article OBJECTIVES: 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. METHODS: 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). RESULTS: 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). CONCLUSION: 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. Wolters Kluwer - Medknow 2020 2020-01-07 /pmc/articles/PMC7034209/ /pubmed/31929243 http://dx.doi.org/10.4103/aca.ACA_133_18 Text en Copyright: © 2020 Annals of Cardiac Anaesthesia http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Kaushik, Atul
Kapoor, Aditya
Agarwal, Surendra K
Pande, Shantanu
Tewari, Prabhat
Majumdar, Gauranga
Sinha, Archana
Kashyap, Shiridhar
Khanna, Roopali
Kumar, Sudeep
Garg, Naveen
Tewari, Satyendra
Goel, Pravin
Statin Reload before Off-pump Coronary Artery Bypass Graft: Effect on Biomarker Release Kinetics
title Statin Reload before Off-pump Coronary Artery Bypass Graft: Effect on Biomarker Release Kinetics
title_full Statin Reload before Off-pump Coronary Artery Bypass Graft: Effect on Biomarker Release Kinetics
title_fullStr Statin Reload before Off-pump Coronary Artery Bypass Graft: Effect on Biomarker Release Kinetics
title_full_unstemmed Statin Reload before Off-pump Coronary Artery Bypass Graft: Effect on Biomarker Release Kinetics
title_short Statin Reload before Off-pump Coronary Artery Bypass Graft: Effect on Biomarker Release Kinetics
title_sort statin reload before off-pump coronary artery bypass graft: effect on biomarker release kinetics
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7034209/
https://www.ncbi.nlm.nih.gov/pubmed/31929243
http://dx.doi.org/10.4103/aca.ACA_133_18
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