ABSTRACT
Acute kidney injury (AKI) is a highly prevalent and a critical complication of cardiac surgery (CS). Serum lactate (sLac) levels have consistently shown an association with morbimortality after CS. We performed a cross-sectional study including 264 adult patients that had a cardiac surgery between January and December 2020. Logistic regression analysis was performed to determine factors associated with AKI development. We measured the postoperative levels of sLac for all participants immediately after CS (T0) and at 4 h (T4) after the surgical intervention. A linear regression model was used to identify the factors influencing both sLac metrics. We identified four risk predictors of AKI; one was preoperative (atrial fibrillation), one intraoperative (cardiopulmonary bypass time), and two were postoperative (length of hospital stay and postoperative sLac). T0 and T4 sLac levels were higher among CS-AKI patients than in Non-CS-AKI patients. Postoperative sLac levels were significant independent predictors of CSA-AKI, and sLac levels are influenced by length of hospital stay, the number of transfused packed red blood cells, and the use of furosemide in CS-AKI patients. These findings may facilitate the earlier identification of patients susceptible to AKI after CS.
ABSTRACT
Background: Intramural coronary hematoma (ICH) is an unusual cause of acute coronary syndrome, and it represents a diagnostic challenge, especially in young patients in which it is not considered among the differential causes of acute myocardial ischemia. Clinical case: 40-year-old female, with type 2 diabetes and no other cardiovascular risk factors, who assisted to the Emergency Room with chest pain. In her first evaluation, electrocardiographic abnormalities, and troponin I elevation were found. A cardiac catheterization was performed, in which a proximal obstruction of the left anterior descending artery was observed, and then an optical coherence tomography (OCT) confirmed the presence of an ICH without a dissection flap. A stent was implanted in the obstruction area, with adequate angiographic outcome. The patient had a satisfactory evolution and was discharged to home without evidence of systolic dysfunction and is free of cardiovascular symptoms at 6-month follow-up. Conclusions: ICH must be considered within the differential diagnosis of acute myocardial ischemia in young patients, especially females. Intravascular image diagnosis is essential for the adequate diagnosis and treatment. Treatment must be individualized considering the extent of ischemia.
Introducción: el hematoma intramural coronario (HIC) es una causa poco frecuente de síndrome isquémico coronario agudo y representa un reto diagnóstico, en especial en pacientes jóvenes en los que puede llegar a no ser contemplado dentro de las causas de isquemia cardiaca no ateroesclerótica. Caso clínico: mujer de 40 años, con diabetes tipo 2 y sin otro factor de riesgo cardiovascular, quien acudió al Servicio de Urgencias manifestando dolor torácico. En su evaluación inicial se encontraron alteraciones en el electrocardiograma y elevación de troponina I. Se decidió la realización de coronariografía donde se observó lesión severa de la arteria descendente anterior. El estudio fue complementado con una tomografía de coherencia óptica intracoronaria, la cual confirmó la presencia de HIC sin disección, por lo que se decidió implantar un stent en el segmento arterial afectado con resultado angiográfico exitoso. La convalecencia posterior evolucionó sin complicaciones, lo que posibilitó su egreso a domicilio sin disfunción sistólica en el ecocardiograma y con seguimiento sin eventualidades a los 6 meses. Conclusiones: el HIC es una entidad que debe ser considerada como una causa posible de isquemia miocárdica aguda en pacientes jóvenes y que requiere de la complementación diagnóstica con estudios de imagen intravascular. Su tratamiento debe ser individualizado en el contexto de la extensión de la isquemia.
