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Title: Tryptase and myocardial injury - studies with aprotinin administration

Mirosław Mussur, Janusz Zasłonka, Ryszard Jaszewski, Alicja Iwaszkiewicz, Józef Kędziora, Janina Wyczółkowska
Original articles
Polish Journal of Cardiology
Start page:
Final page:
aprotinin, tryptase, troponin T, CK-MB, GOT, myocardial injury

Aim: The effect of low dose (3 million KIU) of aprotinin, a serine protease inhibitor, on serum activity of mast cell serine protease- tryptase, and myocardial injury indicators: troponin T, CK-MB and GOT was investiga-ted in thirty patients undergoing elective coronary artery bypass graft surgery (CABG) under light systemie hypothermic cardiopulmonary bypass (CPB), and with the use of antegrade cold intermittent crystalloid car-dioplegia. Methods: The patients were divided into two groups: A - without and B - with aprotinin of 15 subjects each. Blood samples were taken from the radial artery before cannulation of the aorta, at the first minutę of reper-fusion and ten hours after the aortic cross elamp release. Results: Tryptase activity (U/L) significantly inereased just after the ischemic period of the heart in both groups from 1.3±0.1 to 1.9±0.1 (p<0.001)inthegroupA, and from 1.3±0.1 to 1.9±0.2 (p<0.001) in thegro-up B, and then returned nearlyto initial value ten hours after cross elamp removal (1.6±0.6, and 1.2±0.1, group A and B respectively; p<0.05). Troponin T concentration (ng/ml) increased gradually during theentire investigation period in the group A: 0.3±0.1 -> 0.6±0.3 -> 3.4±2.6 (both p<0.001), and in the group B: 0.4±0.2^-1.0±0.5-» 1.2±1.0(both p<0.05). However, it was about 3-times lower(p<0.01) in the group B ten hours after aorta cross clamp removal. GOT activity (U/L) increased gradually during the entire inve-stigation period: 31.1 ±7.5 -> 37.1 ±10.3 (p<0.05) -> 80.1 ±41.7 (p<0.001) in the group A, and 31.5±5.7 -> 40.9±17.5 (ns) -> 73.1 ±36.3 (p<0.05) in the group B, whereas CK-MB activity (U/L) increased more rapidly just after aorta cross clamp removal: 27.5±17.7 -> 72.2±31.1 -> 91.2±56.9 (both p<0.001), and 21.6±5.0 -> 61.7±24.4 -> 80.2±475 (both p<0.01), respectively. Nostatistically significant differenceswere found between the groups with respect to GOT and CK-MB activities. Conclusions: Low dose of aprotinin used during CABG surgery significantly diminishes plasma tryptase activi-ty and troponin-T release studied ten hours after aortic cross clamp release, and does not affect CK-MB and GOT activities. This suggests a protective role of aprotinin against troponin complex breakdown and aprotinin involvement in tryptase inhibition. The results indicate necessity of earlier aprotinin administration, i.e. priorto CABG surgery. Troponin complex breakdown may underlie myocardial stunning.