actabiomedicaActa Biomedica ScientificaActa Biomedica Scientifica2541-94202587-9596Scientific Centre for Family Health and Human Reproduction Problems10.29413/ABS.2019-4.5.15actabiomedica-2176Research ArticleХИРУРГИЯSURGERYПослеоперационные кардиальные ишемические осложнения у больных раком лёгкогоPostoperative Cardiac Ischemic Complications in Lung Cancer Patientshttps://orcid.org/0000-0002-8993-2503БольшедворскаяО. А.BolshedvorskayaO. A.

врач-терапевт торакального хирургического отделения

664035, г. Иркутск, ул. Фрунзе, 32, Россия

General Physician of the Thoracic Surgery Department

olbo17@yandex.ruhttps://orcid.org/0000-0002-6516-3180ПротасовК. В.ProtasovK. V.

доктор медицинских наук, профессор, заведующий кафедрой кардиологии и функциональной диагностики

664049, г. Иркутск, Юбилейный, 100, Россия

Dr. Sc. (Med.), Professor, Head of the Department of Cardiology and Functional Diagnostics

k.v.protasov@gmail.comhttps://orcid.org/0000-0001-5902-0274БатороевЮ. К.BatoroevYu. K.

доктор медицинских наук, профессор кафедры онкологии

664035, г. Иркутск, ул. Фрунзе, 32, Россия

664049, г. Иркутск, Юбилейный, 100, Россия

Dr. Sc. (Med.), Professor of the Pathology Department

https://orcid.org/0000-0003-3064-8441УлыбинП. С.UlybinP. S.

врач-хирург торакального хирургического отделения

664035, г. Иркутск, ул. Фрунзе, 32, Россия

 

Surgeon of the Thoracic Surgery Department

smile_p79@mail.ruhttps://orcid.org/0000-0002-1777-5449ДворниченкоВ. В.DvornichenkoV. V.

доктор медицинских наук, профессор, главный врач, заведующая кафедрой онкологии

664035, г. Иркутск, ул. Фрунзе, 32, Россия

664049, г. Иркутск, Юбилейный, 100, Россия

Dr. Sc. (Med.), Professor, Chief Doctor; Head of the Oncology Department

vv.dvornichenko@gmail.comГБУЗ «Областной онкологический диспансер»Irkutsk Regional Oncology CenterИркутская государственная медицинская академия последипломного образования – филиал ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииIrkutsk State Medical Academy of Postgraduate Education – Branch Campus of the Russian Medical Academy of Continuing Professional EducationГБУЗ «Областной онкологический диспансер»; Иркутская государственная медицинская академия последипломного образования – филиал ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииIrkutsk State Medical Academy of Postgraduate Education – Branch Campus of the Russian Medical Academy of Continuing Professional EducationГБУЗ «Областной онкологический диспансер»; Иркутская государственная медицинская академия последипломного образования – филиал ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииIrkutsk Regional Oncology Center; Irkutsk State Medical Academy of Postgraduate Education – Branch Campus of the Russian Medical Academy of Continuing Professional Education201912112019459197Copyright © Большедворская О.А., Протасов К.В., Батороев Ю.К., Улыбин П.С., Дворниченко В.В., 20192019Большедворская О.А., Протасов К.В., Батороев Ю.К., Улыбин П.С., Дворниченко В.В.Bolshedvorskaya O.A., Protasov K.V., Batoroev Y.K., Ulybin P.S., Dvornichenko V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.actabiomedica.ru/jour/article/view/2176

Обоснование. Периоперационная ишемия миокарда нередко осложняет внесердечные хирургические вмешательства. Не решены проблемы её прогнозирования, диагностики, лечения и профилактики. Частота, структура и клинические особенности кардиальных ишемических осложнений хирургического лечения рака лёгкого изучены недостаточно.Цель исследования: изучить частоту послеоперационного инфаркта миокарда и ишемии миокарда при хирургическом лечении больных немелкоклеточным раком лёгкого.Методы. Рассчитывалась частота обнаружения (%) инфаркта миокарда (ИМ) с подъёмом и без подъёма сегмента ST электрокардиограммы, острой ишемии миокарда в сплошной выборке пациентов онкологического стационара (n = 2051), подвергшихся хирургическому лечению по поводу немелкоклеточного рака лёгкого. Путём сравнительного анализа и вычисления отношения шансов (ОШ) изучались взаимосвязи кардиальных ишемических событий с возрастом, типом операции, распространённостью и локализацией опухоли. Проанализированы клинические и патоморфологические проявления послеоперационного инфаркта миокарда.Результаты. Кардиальные ишемические осложнения торакотомий по поводу рака лёгкого встречались в 2,73 % (95% ДИ 1,98–3,48) случаев. Инфаркт миокарда с подъёмом сегмента ST зафиксирован у 1,07 % (95% ДИ 0,58–1,57) пациентов, ИМ без подъёма сегмента ST – у 0,54 % (95% ДИ 0,17–0,9), ишемия миокарда – у 1,12 % (95% ДИ 0,62–1,63). Отмечено увеличение частоты ишемических событий после пневмонэктомий, по сравнению с лобэктомиями (ОШ 6,5, 95% ДИ 3,5–12,2) и после правосторонних пневмонэктомий, по сравнению с левосторонними (ОШ 3,2, 95% ДИ 1,6–6,3), а также в возрасте старше 70 лет. Госпитальная летальность от ИМ составила 39,3 %. По данным аутопсий пациентов, умерших от ИМ, коронарный атеротромбоз обнаружен в 2 из 22 случаев.Заключение. При хирургическом лечении немелкоклеточного рака лёгкого кардиальные ишемические события развиваются у 2,73 % пациентов. Наибольший риск ассоциирован с правосторонними  пневмонэктомиями.

Background. Perioperative myocardial ischemia often complicates extracardiac surgery. The problems of its prediction, diagnostics, treatment and prevention are not solved. Frequency, structure and clinical features of cardiac ischemic complications of surgical treatment of lung cancer are not well understood.The aim of the study was to investigate the frequency of postoperative myocardial infarction and myocardial ischemia in the surgical treatment of patients with non-small cell lung cancer.Methods. The frequency (%) of myocardial infarction (MI) with and without ST segment elevation of electrocardiogram, acute myocardial ischemia in a complete sample of cancer patients (n = 2051) who underwent treatment for non-small cell lung cancer for the last 10 years was calculated. By comparing the relative indicators and calculating the Odds Ratio (OR), we studied the relationship between the cardiac ischemic events with age, type of surgery, prevalence and localization of the tumour. The clinical manifestations and pathomorphology of postoperative myocardial infarction were analysed.Results. Cardiac ischemic complications of thoracotomy for lung cancer occurred in 2.73 % (95% CI 1.98–3.48) cases. Myocardial infarction with ST segment elevation was recorded in 1.07 % (95% CI 0.58–1.57) patients, MI without ST segment elevation – in 0.54 % (95% CI 0.17–0.9), myocardial ischemia – in 1.12 % (95% CI 0.62–1.63). An increase in the frequency of ischemic events after pneumonectomy was observed compared with lobectomy (OR 6.5, 95% CI 3.5–12.2) and after right-sided pneumonectomy compared with left-sided one (OR 3.2, 95% CI 1.6–6.3), and also the age over 70. Hospital mortality from MI was 39.3 %. According to autopsies of patients who died of МI, coronary atherothrombosis was detected in 2 of 22 cases.Conclusion. In the surgical treatment of non-small cell lung cancer, cardiac ischemic events develop in 2.73 % of patients. The greatest risk is associated with right-sided pneumonectomy.

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Interact Cardiovasc Thorac Surg. 2015; 20(3): 316-321. doi: 10.1093/icvts/ivu417Pricopi C, Mordant P, Rivera C, Arame A, Foucault C, Dujon A, et al. Postoperative morbidity and mortality after pneumonectomy: a 30-year experience of 2064 consecutive patients. Interact Cardiovasc Thorac Surg. 2015; 20(3): 316-321. doi: 10.1093/icvts/ivu417Pricopi C, Mordant P, Rivera C, Arame A, Foucault C, Dujon A, et al. Postoperative morbidity and mortality after pneumonectomy: a 30-year experience of 2064 consecutive patients. Interact Cardiovasc Thorac Surg. 2015; 20(3): 316-321. doi: 10.1093/icvts/ivu417Rodríguez M, Gómez MT, Jiménez MF, Aranda JL, Novoa N, Varela G. The risk of death due to cardiorespiratory causes increases with time after right pneumonectomy: a propensity score-matched analysis. Eur J Cardiothorac Surg. 2013; 44(1): 93-97. doi: 10.1093/ejcts/ezs620Rodríguez M, Gómez MT, Jiménez MF, Aranda JL, Novoa N, Varela G. The risk of death due to cardiorespiratory causes increases with time after right pneumonectomy: a propensity score-matched analysis. Eur J Cardiothorac Surg. 2013; 44(1): 93-97. doi: 10.1093/ejcts/ezs620Rodríguez M, Gómez MT, Jiménez MF, Aranda JL, Novoa N, Varela G. The risk of death due to cardiorespiratory causes increases with time after right pneumonectomy: a propensity score-matched analysis. Eur J Cardiothorac Surg. 2013; 44(1): 93-97. doi: 10.1093/ejcts/ezs620Rodríguez M, Gómez MT, Jiménez MF, Aranda JL, Novoa N, Varela G. The risk of death due to cardiorespiratory causes increases with time after right pneumonectomy: a propensity score-matched analysis. Eur J Cardiothorac Surg. 2013; 44(1): 93-97. doi: 10.1093/ejcts/ezs620Gaissert HA, Keum DY, Wright CD, Ancukiewicz M, Monroe E, Donahue DM, et al. POINT: Operative risk of pneumonectomy - influence of preoperative induction therapy. J Thorac Cardiovasc Surg. 2009; 138(2): 289-94. doi: 10.1016/j.jtcvs.2008.11.069Gaissert HA, Keum DY, Wright CD, Ancukiewicz M, Monroe E, Donahue DM, et al. POINT: Operative risk of pneumonectomy - influence of preoperative induction therapy. J Thorac Cardiovasc Surg. 2009; 138(2): 289-94. doi: 10.1016/j.jtcvs.2008.11.069Gaissert HA, Keum DY, Wright CD, Ancukiewicz M, Monroe E, Donahue DM, et al. POINT: Operative risk of pneumonectomy - influence of preoperative induction therapy. J Thorac Cardiovasc Surg. 2009; 138(2): 289-94. doi: 10.1016/j.jtcvs.2008.11.069Gaissert HA, Keum DY, Wright CD, Ancukiewicz M, Monroe E, Donahue DM, et al. POINT: Operative risk of pneumonectomy - influence of preoperative induction therapy. J Thorac Cardiovasc Surg. 2009; 138(2): 289-94. doi: 10.1016/j.jtcvs.2008.11.069Puelacher C, Lurati-Buse G, Singeisen H, Dang M, Cuculi F, Müller C. Perioperative myocardial infarction/injury after noncardiac surgery. Swiss Med Wkly. 2015; 145: w14219. doi: 10.4414/smw.2015.14219Puelacher C, Lurati-Buse G, Singeisen H, Dang M, Cuculi F, Müller C. Perioperative myocardial infarction/injury after noncardiac surgery. Swiss Med Wkly. 2015; 145: w14219. doi: 10.4414/smw.2015.14219Puelacher C, Lurati-Buse G, Singeisen H, Dang M, Cuculi F, Müller C. Perioperative myocardial infarction/injury after noncardiac surgery. Swiss Med Wkly. 2015; 145: w14219. doi: 10.4414/smw.2015.14219Puelacher C, Lurati-Buse G, Singeisen H, Dang M, Cuculi F, Müller C. Perioperative myocardial infarction/injury after noncardiac surgery. Swiss Med Wkly. 2015; 145: w14219. doi: 10.4414/smw.2015.14219Frolovicheva IS, Poltavskaya MG, Syrkin AL. Comparative clinical and pathological study of perioperative and ordinary fatal myocardial infarction. Cardiology and Cardiovascular Surgery. 2016; (5): 23-28. doi: 10.17116/kardio20169523-28 (In Russ.)Frolovicheva IS, Poltavskaya MG, Syrkin AL. Comparative clinical and pathological study of perioperative and ordinary fatal myocardial infarction. Cardiology and Cardiovascular Surgery. 2016; (5): 23-28. doi: 10.17116/kardio20169523-28 (In Russ.)Frolovicheva IS, Poltavskaya MG, Syrkin AL. Comparative clinical and pathological study of perioperative and ordinary fatal myocardial infarction. Cardiology and Cardiovascular Surgery. 2016; (5): 23-28. doi: 10.17116/kardio20169523-28 (In Russ.)Frolovicheva IS, Poltavskaya MG, Syrkin AL. Comparative clinical and pathological study of perioperative and ordinary fatal myocardial infarction. Cardiology and Cardiovascular Surgery. 2016; (5): 23-28. doi: 10.17116/kardio20169523-28 (In Russ.)

The authors declare that there are no conflicts of interest present.