Mehmet Fatih YILMAZ, Süleyman Çağan EFE, Emrah ACAR, Çetin GEÇTİN, Mehmet İNANIR, Can Yücel KARABAY, İbrahim Akın İZGİ, Cevat KIRMA

Stabil Angina Pektorisli Hastalarda Koroner Arter Baypas Cerrahisi Öncesi Ranolazin Tedavisinin Peroperatif Miyokard Hasarı Üzerine Etkisi

Giriş:Stabil anjinapektoris(SAP),mortaliteve yaşamkalitesiüzerindeönemli etkisiolan kronikbirhastalıktır.Ranolazin,bir antianjinal olarak onaylanan bir piperazin türevidir. Öncelikle stabil koroner arter hastalığında ikinci basamak antianjinal olarak kullanılır. Ranolazin geç sodyum kanallarını (INa) bloke ederek etki eder ve sitosolik kalsiyumun yükselmesini önler. Çalışmamız ranalozinin, perioperatif dönemde iskemiyi azaltabileceği ve miyokard hasarını azaltabileceği düşünülerek tasarlanmıştır. Yöntem: Çalışmaya 1ocak 2015 ile 30 haziran 2016 tarihleri arasında Kartal Koşuyolu Yüksek İhtisas Eğitim Araştırma HastanesiKardiyolojiAnabilimDalındakoroner anjiyografi(KAG) uygulanmış ve çokdamar hastalığı veyaLMCAhastalığı tespit edilip, daha sonra Kardiyoloji- Kalp Damar Cerrahisi ortak konseyinde CABG kararı verilen stabil angina pektorisli hastalaralındı.CABGdışındabaşkabircerrahiprosedür(mitralkapakonarımı,mitralkapakdeğişimiaortkapakdeğişimigibi) uygulanan hastalar çalışmadan dışlandı. Araştırma protokolü için hastanemiz etik kurulundan gereken izin alındı. Bulgular: Ranolazin alan grupta ortalama yaş 61,2±8,6 iken standart tedavi alan hastaların ortalama yaşı 57,9±8,8 olarak saptandı. (p=0,073). Hastaların operasyon öncesi değerlendirilen ve işlem sırasındaki mortaliteyi öngörmek amacıyla kullanılan EuroSCORE’ları benzerdi. 1.Grup hastaların ortalama 0. Saattroponin değeri 1.70 (1.13-2.77)iken 2.Grup hastaların 0. Saat troponin değeri 2.76(1.69-6.20) (p=0,01). Sonuç: Çalışmamızda postoperatif olarak hemen bakılan troponin 0 değeri ranolazin alan grupta daha düşük saptandı. 12. Ve 24. Saatte bakılan troponin değerleri bakımından istatistiksel fark saptanmadı. Çalışmamızda erken dönem miyokard hasarının ranolozın tedavisi ile anlamlı olarak azaldığını gösterdik.

The Effect Of Ranolazine Treatment Administered Before Coronary Artery Bypass Surgery On Perioperative Myocardial Damage In Patients With Stable Angina Pectoris

Objective:Ranolazineisapiperazinederivativethathasbeenapprovedasanantianginal agent.Itisprimarilyusedasasecondlineantianginalagentinstablecoronaryarterydisease.Thestudywasdesignedconsideringthattheactiveingredientranalozine, which has antiischemic effectsthrough ischemic sodiumchannels, can reduce ischemia in the perioperative period and reduce the frequency of perioperative myocardialinfarction. Methods: The study included patients with stable angina pectoris who underwent coronary angiography between January 1, 2015 and June 30, 2016 at Koşuyolu Training and Research Hospital and who were diagnosed with multi-vessel disease or LMCA disease, and then for whom the joint council of Cardiology-Cardiovascular Surgery made a decision in favor of coronary artery bypass grafting. Results: The mean age was 61.2 ± 8.6 years in the ranolazine group, while the mean age of the patients receiving standard therapy was 57.9 ± 8.8 years (p = 0.073).The EuroSCOREs of the patients before the operation which were used to predict intraoperative mortality were similar. Mean troponin value of Group 1 patients at 0 hour was 1.70 (1.13-2.77), while mean troponin value of the patients in Group 2 at 0 hour was 2.76(1.69-6.20)(p=0,01). Conclusion:In the presentstudy,the immediate postoperative troponin 0 valuewasfound to be lowerin the ranolazine group. There was no statistical difference in terms of troponin valuesmeasured at 12 and 24 hours.In thisstudy,we showed that early myocardial damage was significantly reduced with ranolazine treatment.

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