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Angiopoietin-2 (Ang-2) is a proangiogenic factor that mediates inflammation and atherosclerosis. We evaluated the predictive value of circulating Ang-2 levels for periprocedural myocardial injury (PMI) in 145 patients undergoing elective percutaneous coronary intervention (PCI), and investigated whether post-PCI Ang-2 levels are influenced by PMI. PMI was defined as a post-procedural troponin elevation above the 5×99th percentile upper reference limit. Blood samples for Ang-2 analysis were collected at admission and on postoperative days 1 and 3. PMI occurred in 40 patients (28%). At baseline, there was no difference in Ang-2 levels between PMI and non-PMI patients (P=0.554). However, a significant interaction effect between PMI occurrence and time on Ang-2 levels was observed (interaction P=0.036). Although serum Ang-2 levels in non-PMI patients gradually decreased, Ang-2 levels in PMI patients did not change between different time-points. Multiple logistic regression analysis revealed that age, total stent length, and serum levels of N-terminal pro-brain natriuretic peptide were independent PMI predictors. These findings indicate that pre-procedural Ang-2 levels do not impact PMI occurrence after elective PCI. However, changes in Ang-2 levels after the procedure are closely related to PMI.

Although cerebrovascular interventions aim to improve long-term neurologic outcome, these procedures are accompanied by a risk of perioperative cerebral hypoperfusion and ischemia. This thesis explored several approaches to improve (neurological) outcome from an anesthetic point of view. In Part I, perioperative respiratory management was studied by assessing the trends in end-tidal carbon dioxide (ETCO2) as seen in clinical practice. In Chapter 2, we found a very large inter-hospital and inter-provider variability in ETCO2 after adjustment for confounders, suggesting that there might still be a lack of evidence to support a specific targeted range. Postoperative pulmonary complications are frequent in neurosurgical patients and can have adverse effects on (neurological) outcome. In Chapter 3, the association between ETCO2 (studying several thresholds) and postoperative pulmonary complications was assessed. Both hypercapnia (ETCO2 >45 mmHg) and severe hypocapnia (ETCO2

Meng Liu,1,2 Pingsheng Wu2 1Emergency Department, Hunan Provincial People’s Hospital, Medical School of Hunan Normal University, Changsha, People’s Republic of China; 2Cardiology Department, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of ChinaCorrespondence: Pingsheng WuCardiology Department, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Road, Guangzhou, People’s Republic of ChinaTel +86 02061641502Email wupingshengnf@sina.comIntroduction: Temporary transvenous cardiac pacing (TTCP) can lead to potential penetration and occasional perforation of the right ventricular wall. No study to date has analyzed the effect of TTCP on myocardial injury by cardiac troponin (cTn) measurement. The present study was designed to investigate perioperative myocardial injury in elective TTCP in noncardiac surgical settings.Patients and Methods: This retrospective study investigated the data collected from August 2018 through March 2020 from 22 eligible patients who underwent elective TTCP for noncardiac procedures. The patients had a median age of 66 (50– 83) years; six (27.3%) of them were women, and all of them had a baseline cTn < 1 upper reference limit (URL). Cardiac biomarker assays were performed before and after TTCP, and their results were compared.Results: After TTCP, cTn > 1 URL was detected in 20 (91%, N=22) patients. Among these 22 patients, paired t-test comparing assay results before and after TTCP lead insertion showed a mean cTn elevation of 3.599 URL (95% CI: 1.566 to 5.632, P< 0.01), and a mean creatine kinase-MB isoform elevation of 0.1550 URL (95% CI: − 0.01239 to 0.3224, P> 0.05).Conclusion: The study demonstrates a high incidence of myocardial injury associated with TTCP, which should be a matter of concern for the involved physicians.Keywords: temporary pacemaker, temporary transvenous cardiac pacing, myocardial injury, bradycardia, perioperative myocardial injury

Background: Routine clinical strategies for the prevention of myocardial infarction (MI) during the surgical procedure of CABG include cross-clamp fibrillation and cardioplegia have failed to decrease the risk of perioperative myocardial injury (PMI). Cyclosporine-A (CsA) might be able to prevent mitochondrial dysfunction and PMI. Methods: In the present clinical trial, patients were divided into two groups (Case receive 2.5 mg/kg CsA and Control receive a placebo) randomly. Moreover, patients were controlled by placebo through a double-blind, single-center trial 4-12 h before anesthesia. Perioperative blood tests include bilirubin, complete blood count, the amount of hemoglobin in whole blood, liver transaminases, and glomerular filtration rate (GFR). Blood samples were taken before surgery and at 24, 48, and 72 h after surgery and serum Troponin-I and CK-MB levels were determined in all blood samples using ELISA. Results: There were no significant differences between the two groups in the results of routine pre-operative blood results, intraoperative variables, and baseline characteristics (P > 0.05). There are significant correlations between cross clamp time and cTnI and CKMB levels in patients taking CsA. In patients with both diabetes and hypertension, postsurgical cTnI and CKMB levels decrease significantly in CsA compared to placebo group on 24, 48, and 72 h (P < 0.05). Moreover, patients with old MI, both postsurgical cTnI and CKMB levels decrease significantly in CsA compared to placebo group on 24 h and 48 h (P < 0.05). Conclusions: In patients with a long cross-clamping period, using an oral CSA single dose before conducting CABG surgery, the risk of PMI could be decreased. Also, oral CsA has protective effect for CABG in diabetic patients with hypertension.

Ziliang Ye,1 Haili Lu,2 Qiang Su,1 Manyun Long,1 Lang Li1 On behalf of the PENMIPCI investigators 1Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China; 2Department of Orthodontics, The Affiliated Dental Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China Background: Previous studies have indicated that nicorandil can reduce perioperative myocardial injury (PMI) in patients undergoing elective percutaneous coronary intervention (ePCI), but this conclusion is still controversial. Additionally, studies reporting on the safety of nicorandil are lacking. Therefore, we performed this prospective study to evaluate the efficacy and safety of nicorandil on PMI in patients undergoing ePCI.Methods: One hundred and forty-six patients with coronary heart disease (CHD) scheduled to undergo ePCI were randomly assigned to the nicorandil group (n=74) or control group (n=72). The primary outcomes were the change in cardiac troponin T (cTnT) and creatine kinase-MB (CK-MB) at 12 and 24 hours after surgery. The secondary outcome was the incidence of major adverse cardiac events (MACE), which was a composite of cardiac death, nonfatal myocardial infarction, new heart failure or coronary revascularization.Results: There was no difference in age (54.76±5.93 vs 56.35±5.22) between the nicorandil group and the control group. In addition, no differences were observed in the cTnT and CK-MB levels between the two groups at admission (all P>0.05). Compared with those in the control group, the cTnT (0.15±0.12 vs 0.12±0.10 at 12 hours and 0.17±0.12 vs 0.13±0.10 at 24 hours) and CK-MB (15.35±8.23 vs 12.31±7.93 at 12 hours and 13.63±8.87 vs 11.13±5.71 at 24 hours) levels in the nicorandil group were significantly decreased after surgery (all P

Recognition of myocardial injury after non-cardiac surgery is difficult, since strong analgesics (e.g. opioids) can mask anginal symptoms, and ECG abnormalities are subtle or transient. Thorough knowledge of the pathophysiological mechanisms is therefore essential. These mechanisms can be subdivided into four groups: type I myocardial infraction (MI), type II MI, non-ischaemic cardiac pathology, and non-cardiac pathology. The incidence of type I MI in patients with a clinical suspicion of perioperative acute coronary syndrome (ACS) is 45–57 %. This percentage is higher in patients with a high likelihood of MI such as patients with ST-elevation ACS. Of note, the generalisability of this statement is limited due to significant study limitations. Non-ischaemic cardiac pathology and non-cardiac pathology should not be overlooked as a cause of perioperative myocardial injury (PMI). Especially pulmonary embolism and dysrhythmias are a common phenomenon, and may convey important prognostic value. Implementation of routine postoperative troponin assessment and accessible use of minimally invasive imaging should be considered to provide adequate individualised therapy. Also, addition of preoperative imaging may improve the stratification of high-risk patients who may benefit from preoperative or perioperative interventions.