| Myocardial injury and systemic fibrinolysis in patients undergoing repair of ruptured abdominal aortic aneurysm: a preliminary report. | |
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MedLine Citation:
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PMID: 11397027 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: ruptured abdominal aortic aneurysm (AAA) is associated with inhibition of systemic fibrinolysis. Hypofibrinolysis is a risk factor for ischaemic myocardial injury, one of the commonest complications of ruptured AAA repair. Cardiac troponin I (cTnI) is one of the most sensitive and specific marker of myocardial injury currently available. OBJECTIVE: To examine, for the first time, the relationship between fibrinolytic activity and myocardial injury in patients operated for ruptured AAA. METHODS: Twenty patients (18 men and 2 women of median age 74, range 65-86 years) undergoing repair of ruptured AAA were prospectively studied. Plasma tissue plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI-1) activity were measured pre-operatively, immediately before and five minutes following aortic clamp release. Serum cTnI was measured pre-operatively, 6 and 24 h following clamp release. Results cTnI was detectable at one or more sample points in 13 (65%) patients, and in 7 out of 8 patients who suffered major cardiac complications. There was a significant negative correlation between pre-operative t-PA activity and cTnI before operation (r =-0.55, p = 0.01) and 6 h ( r =-0.51, p =0.02) after clamp release. There was a significant positive correlation between pre-operative PAI activity and cTnI before operation (r =+0.50, p =0.03), 6 h ( r =+0.47, p =0.04) and 24 h ( r =+0.50, p =0.03) after clamp release. There was no correlation between pre- and intra-operative hypotension or blood transfusion requirement and cTnI release. CONCLUSIONS: Hypofibrinolysis during ruptured AAA repair is associated with the development of peri-operative myocardial injury. The causal mechanisms underlying this state are not clear but treatment of this prothrombotic/hypofibrinolytic diathesis may help to limit myocardial cell necrosis. |
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Authors:
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P C Haggart; D J Adam; P F Ludman; C A Ludman; A W Bradbury |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery Volume: 21 ISSN: 1078-5884 ISO Abbreviation: Eur J Vasc Endovasc Surg Publication Date: 2001 Jun |
Date Detail:
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Created Date: 2001-06-08 Completed Date: 2001-07-19 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 9512728 Medline TA: Eur J Vasc Endovasc Surg Country: England |
Other Details:
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Languages: eng Pagination: 529-34 Citation Subset: IM |
Copyright Information:
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Copyright 2001 Harcourt Publishers Limited. |
Affiliation:
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University Department of Vascular Surgery, Birmingham Heartlands & Solihull NHS Trust, Birmingham, UK. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Aortic Aneurysm, Abdominal / surgery* Aortic Rupture / surgery* Biological Markers Female Fibrinolysis* Humans Male Myocardial Ischemia / blood, diagnosis, physiopathology* Plasminogen Activator Inhibitor 1 / blood Postoperative Complications / blood, diagnosis, physiopathology* Prospective Studies Statistics, Nonparametric Tissue Plasminogen Activator / blood Troponin I / blood |
| Chemical | |
Reg. No./Substance:
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0/Biological Markers; 0/Plasminogen Activator Inhibitor 1; 0/Troponin I; EC 3.4.21.68/Tissue Plasminogen Activator |
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