Impact of anesthetic strategy on cardiac rhythm and oxidative stress in patients with STEMI undergoing urgent percutaneous coronary intervention

In patients with ST-segment elevation acute coronary syndrome (STEMI) undergoing urgent percutaneous coronary intervention (PCI), not only timely reperfusion but also intraope­rative cardiac rhythm stability and the severity of oxidative stress are of major clinical importance. Ischemia-reperfusion myocardial injury is associated with an increased risk of arrhythmias, activation of lipid peroxidation, and depletion of antioxidant defense, which justifies the evaluation of different anesthetic management strategies during urgent PCI. Objective: to assess the effect of different anesthetic management regimens on intraoperative cardiac rhythm and oxidative stress markers in patients with STEMI undergoing urgent percutaneous coronary intervention. Materials and methods. The study included 90 patients with STEMI who were divided into 3 groups of 30 patients each according to the anesthetic regimen used. Group I received standard analgosedation with sibazone and fentanyl. Group II received multimodal anesthesia with fentanyl, propofol, paracetamol, and lidocaine. Group III received the same multimodal regimen supplemented with edaravone. Cardiac rhythm was assessed in the preoperative, intraoperative, and early postoperative periods. Oxidative stress was evaluated by measuring malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GPx) at the beginning and at the end of the procedure. Results. In the preoperative period, rhythm disturbances were predominantly transient. During coronary artery stenting, ventricular extrasystole and sinus tachycardia were the most frequent rhythm disturbances, with the highest incidence observed in Group I. The incidence of ventricular extrasystole during the intervention was 40.0% in Group I, 23.3% in Group II, and 20.0% in Group III; the incidence of sinus tachycardia was 33.3%, 13.3%, and 10.0%, respectively. In the early postoperative period, patients in Groups II and III also demonstrated a more favorable rhythm profile. At baseline, the groups were comparable in terms of MDA, SOD, and GPx levels. By the end of the procedure, all groups showed an increase in MDA, a decrease in SOD, and an increase in GPx. The most pronounced changes were observed in Group I, whereas the least marked changes were found in Group III. Statistically significant intergroup differences at the end of the intervention were detected for SOD only (p=0.031), with the lowest level in Group I and the best preservation of enzyme activity in Group III. Conclusions. Multimodal anesthetic management in patients with STEMI undergoing urgent PCI was associated with a lower incidence of intraoperative cardiac rhythm disturbances and less pronounced oxidative stress compared with standard analgosedation. The most favorable changes were observed with multimodal anesthesia combined with edaravone, which may indicate a beneficial effect on myocardial electrical stability and and reduce oxidative stress.