Association of PTX-3 and ST-2 with myocardial injury in non-cardiac surgery

Aim : Non-cardiac major surgical operations cause hemodynamic stress on the myocardium and this process can cause myocardial injury. Myocardial injury observed postoperatively has been accepted as an important complication associated with short- and long-term morbidity and mortality. Cardiac complications are commonly seen after major surgery. The incidence of perioperative myocardial infarction/injury in patients undergoing major surgery has been more common in recent years. Recently, myocardial injury after non-cardiac surgery diagnosed by asymptomatic troponin elevation, which carries a poor prognosis, has resulted in an increased frequency of postoperative cardiac events. Mean while Pentraxin-3 (PTX3) is a bill marker produced in response to inflammatory stimuli and highly expressed in the heart. Syntenin- 2, on the other hand, is a biomarker showing cardiac fibrosis caused by cardiac mechanical stress which is assumed to adversely affect prognosis in the short term. Measured ST2 and PTX-3 maybe an independent predictor of post-surgical myocardial injury and cardiac troponin elevation. In this study, based on current international guidelines and important studies; We aimed to evaluate the relationship between PTX-3 and ST2 baseline values measured before surgery in patients who underwent intermediate or high-risk surgery, patients with myocardial damage after non-cardiac surgery with the potential for prevention and treatment, and patients who did not show myocardial damage. Materials and methods: Between 2021-2023, in Zonguldak Bulent Ecevit University Hospital, a total of 340 patients who underwent moderate or high risk operation were taken into evaluation. The patients' demographic information , medical charts and laboratory parameters were recorded. Patients with normal troponin values before surgery and those with troponin values above the 99th percentile at 24 and 72 hours after surgery were considered the group with myocardial damage. The patients were evaluated in two groups as non-myocardial injury (n=261; avarage age:65.95-+11.2 years) and those with myocardial injury after operation (n=79 avarage age:67.58-+11.48 years). In PTX-3 and ST-2 biomarkers taken before operation, it was investigated whether there was a statistically significant difference between the group with and without myocardial injury. Results: There was no statistically significant difference between the groups with and without myocardial injury in terms of age, gender, BMI, comorbidities and medical treatments. No statistically significant difference was found between laboratory variables except PTX-3 and CRP between those with or without myocardial injury. Compared to the group without myocardial injury, the PTX-3 level was found to be significantly higher (0.021 -+0.06 vs 0.24-+0.11, p=0.007) in the group with myocardial injury. When the two groups were compared in terms of laboratory values, there was again a difference in CRP levels (15.8-+26.5 vs 23.5-+39.1, p=0.047). According to the statistical analysis, having emergency operation in the group with myocardial injury (%19 vs %9.2, p=0.017), having operation in general anesthesia (%91.1 vs %79.7, p=0.019), high ASA score (%12.7 vs %8, p=0.038) the revised cardiac risk index (%15.2 vs %5.7, p=<0.001) were statistically more significantly higher. Also, the history of CAD in patients who went under surgery, the history of CAD in patients with myocardial injury ( %39.2 vs %20.3, p=0.001) and the history of CHF (%24.1 vs %14.2, p=0.038) were detected meaningfully higher. Hypotensive course of patients with myocardial throughout the operation (%46.8 vs %33.3, p=0.009), vasopressor therapy inititation rate (%5.1 vs %1.1, p=0.032), rate of seen bradycardia (%25.3 vs %13, p=0.009), low saturation (%10.1 vs %2.7, p=0.005) were evaluated significantly high in statics. In addition, the longer the operation time (186-+95 vs 159-+77 minutes) the more myocardial injury was observed (p=0.020). In the logistic regression analysis, CRP, operation under general anesthesi, bradycardia, hypoxia and a >3 point revised cardiac risk index were independent risk factors. Also, independenly of other risk factors, it was investigated whether PTX-3 was an independent MINS specifier or not and in regression analysis, PTX-3 was found to be statistically significant in predicting MINS (OR: 1.043; %95 GA, 1.011-1.075; p=0,008). In order to predict myocardial damage, ROC analysis was performed to determine the cut-off value of PTX-3 and CRP. Accordingly, patients with a PTX-3 value ≥21 pg/ml were high, patients with PTX-3 level <0.21 pg/ml were determined low group. According to the 18.2 mg/dl value obtained for CRP, 2 groups were formed. Taking the low CRP / low PTX-3 group as the reference point, the power of CRP and PTX-3 groups to predict myocardial injury was evaluated. According to this, high CRP /low PTX-3 (OR:2.28;%95 GA, 0.98-4.93; p=0.054) although not statistically significant, low CRP/high PTX-3 (OR:2.68;%95 GA, 1.30-5.49; p=0.007) and high CRP /high PTX-3 (OR:4.22;%95 GA, 1.99-8.96; p<0.001) could predict myocardial injury. Conclusion: In patients, who underwent surgery in non-cardiac moderate or high risk group ,and had preoperative myocardial injury; high risk PTX-3 values were detected. PTX-3 measurement should definitely be considered in patients in moderate or high risk group. It was observed that the troponin values used to detect myocardial damage in the postoperative period were also high in the group whose baseline PTX-3 levels were high in the patients before the operation. If this PTX-3 biomarker is high, more frequent follow-up and more intensive treatment should be planned.