Document Detail

Myocardial injury and systemic fibrinolysis in patients undergoing repair of ruptured abdominal aortic aneurysm: a preliminary report.
MedLine Citation:
PMID:  11397027     Owner:  NLM     Status:  MEDLINE    
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.
P C Haggart; D J Adam; P F Ludman; C A Ludman; A W Bradbury
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
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:
Created Date:  2001-06-08     Completed Date:  2001-07-19     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9512728     Medline TA:  Eur J Vasc Endovasc Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  529-34     Citation Subset:  IM    
Copyright Information:
Copyright 2001 Harcourt Publishers Limited.
University Department of Vascular Surgery, Birmingham Heartlands & Solihull NHS Trust, Birmingham, UK.
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MeSH Terms
Aged, 80 and over
Aortic Aneurysm, Abdominal / surgery*
Aortic Rupture / surgery*
Biological Markers
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
Reg. No./Substance:
0/Biological Markers; 0/Plasminogen Activator Inhibitor 1; 0/Troponin I; EC Plasminogen Activator

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