scholarly journals Effectiveness of Ranolazine to Prevent Myocardial Injury During Elective Percutaneous Coronary Intervention

2019 ◽  
Vol 10 (1) ◽  
pp. 43-49
Author(s):  
SM Mamun Iqbal ◽  
Syed Ali Ahsan ◽  
Kasekh Akhtar Jahan ◽  
Sohely Nazneen Eva
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Myocardial Injury ◽  
Troponin I ◽  
Chronic Stable Angina ◽  
Coronary Intervention ◽  
Control Group ◽  
Interventional Study ◽  
Elective Percutaneous Coronary Intervention ◽  
Percutaneous Coronary ◽  
Periprocedural Myocardial Injury

Background: Ranolazine is a novel antianginal drug that reduces intracellular accumulation of calcium ion in ischemic myocardium. A pilot randomized study (n=70) has shown that pretreatment with ranolazine 1000mg twice daily for 7days significantly reduced periprocedural myocardial injury (PMI) in elective Percutaneous coronary intervention (PCI). Our objective was to detect whether similar effect could be obtained by ranolazine pretreatment through an interventional study. Materials & Methods: 110 patients with chronic stable angina scheduled for elective PCI were enrolled in an interventional study. For 7 days before the procedure, 55 patients were allocated to receive ranolazine 1000 mg twice daily (ranolazine group) and 55 patients didn't receive ranolazine (control group). Serum creatinine kinase-MB (CK-MB) and Troponin I levels were measured at baseline and 24 hours post procedure. Results: Periprocedural myocardial injury [i.e. an elevation of serum biomarkers (preferably cardiac troponins) above the 99th percentile of upper reference limit (URL)] was detected less commonly after PCI in ranolazine than in control group (11% vs. 27%, p=0.0001). Also, PCI-related myocardial infarction [i.e., post procedural increase in CK-MB>3 times above the URL] tended to be lower in the ranolazine versus placebo group: 1.8% versus 5.45%, P=0.0002. 24 hours post procedural levels of cardiac markers were also significantly lower in the ranolazine versus control group (CK-MB: 2.42±2.05 versus 7.02±9 ng/ml, P=0.001; Troponin 1: 0.447±0.74 versus 1.18±1.6 ng/ml, P=0.004). No significant adverse effect of the drug was reported. Conclusion: So, we have concluded that ranolazine was effective in significantly reducing the periprocedural myocardial injury in elective PCI. Anwer Khan Modern Medical College Journal Vol. 10, No. 1: Jan 2019, P 43-49

scholarly journals Effects of Trimetazidine Pretreatment on Endothelial Dysfunction and Myocardial Injury in Unstable Angina Patients Undergoing Percutaneous Coronary Intervention

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Shuai Shao ◽  
Zhaozhao Shi ◽  
Gary Tse ◽  
Xinghua Wang ◽  
Yanping Ni ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Endothelial Dysfunction ◽  
Unstable Angina ◽  
Myocardial Injury ◽  
Troponin I ◽  
Perioperative Period ◽  
Coronary Intervention ◽  
Control Group ◽  
Fatty Acid Binding ◽  
Percutaneous Coronary

Objectives. Trimetazidine is an anti-ischemic medication licensed for the treatment of angina pectoris. However, the molecular mechanisms underlying its action remain incompletely elucidated. In this study, therefore, we examined the potential beneficial effects of trimetazidine on myocardial injury and endothelial dysfunction in patients with unstable angina in the perioperative period of percutaneous coronary intervention (PCI). Methods. A total of 97 patients with unstable angina were randomly divided into trimetazidine (n = 48) and control (n = 49) groups. All subjects received standard medical therapy. The trimetazidine group additionally received 20 mg trimetazidine three times daily 24 hours before and after PCI. Serum levels of creatine kinase-muscle/brain (CK-MB), cardiac troponin I (cTnI), heart-type fatty acid-binding protein (h-FABP), von Willebrand factor (vWF), and nitric oxide (NO) were measured before and the morning following PCI. Results. In the control group, levels of CK-MB, cTnI, and vWF were significantly elevated (P<0.05) and NO level was decreased after PCI (P<0.05). By contrast, no significant changes in the levels of these proteins were observed in the trimetazidine group after PCI (P>0.05). Moreover, h-FABP levels were not significantly altered after PCI whether in the control or in the trimetazidine group (P>0.05). Finally, a time-dependent increase in the levels of h-FABP from 0 to 6 hours after PCI, followed by a progressive decline, was observed (P<0.05). Conclusions. PCI induces endothelial dysfunction and myocardial damage in patients with unstable angina. Trimetazidine therapy in the perioperative period can reduce this damage.

scholarly journals Effects of Shen-Yuan-Dan on Periprocedural Myocardial Injury and the Number of Peripheral Blood Endothelial Progenitor Cells in Patients with Unstable Angina Pectoris Undergoing Elective Percutaneous Coronary Intervention

2022 ◽  
Vol 2022 ◽  
pp. 1-10
Author(s):  
Zhenmin Zhang ◽  
Wenlong Xing ◽  
Hongxu Liu ◽  
Qi Zhou ◽  
Xinyi Liu ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Peripheral Blood ◽  
Myocardial Injury ◽  
Adverse Reactions ◽  
Coronary Intervention ◽  
Elective Percutaneous Coronary Intervention ◽  
Percutaneous Coronary ◽  
Group A ◽  
Group B ◽  
Periprocedural Myocardial Injury

Objectives. We aimed to investigate the effects of Shen-Yuan-Dan (SYD), a Chinese medicine preparation, on periprocedural myocardial injury (PMI) and the number of peripheral blood endothelial progenitor cells (EPCs) in patients with unstable angina pectoris (UA) who underwent elective percutaneous coronary intervention (PCI). Methods. Patients were randomly divided into the experimental (group A) and control (group B) groups through the random number table method. In group A, patients concurrently received the conventional western treatment and SYD orally (4 capsules/time, 3 times/d, from 3 d before surgery to 7 d after surgery). In group B, patients received conventional Western medicine treatment. Both groups underwent coronary angiography, and patients undergoing PCI were eventually included in the study. The following patient data were collected: incidence of PMI, serum CK-MB content before PCI, 4 h, 24 h, and 7 d after PCI, number of CD45dim/-CD34+CD309+ peripheral venous EPCs, and number of CD184 coexpressed EPCs. The incidence of adverse reactions and 30-day major adverse cardiovascular events (MACEs) were also recorded. Results. Sixty-two patients were finally included in this study, with 32 and 30 in groups A and B, respectively. In group A, the number of peripheral blood EPCs and the number of CD184 coexpressed EPCs at 1 h before surgery were higher than those at 3 d before surgery (37.24 ± 25.20 vs. 22.78 ± 9.60/ml; P < 0.001 and 23.38 ± 15.30 vs. 13.54 ± 8.08/ml; P < 0.001 , resp.). The number of peripheral blood EPCs and number of CD184 coexpressed EPCs at 4 h after surgery were lower than those at 1 h before surgery (25.30 ± 11.90 vs. 37.24 ± 25.20/ml; P = 0.019 and 15.38 ± 8.78 vs. 23.38 ± 15.30/ml; P = 0.013 , resp.), but there was no difference at 24 h and at 7 d after surgery in comparison with that at 1 h before surgery ( P > 0.05 ). In group B, compared with that at 1 h before surgery, there existed a decline in the number of EPCs in peripheral blood and the number of CD184 coexpressed EPCs at 4 h after surgery, but without a statistical difference ( P > 0.05 ). Comparing both groups, it was found that the incidence of PMI in group A was lower (6.25% vs. 26.67%; P = 0.04 ), and the serum CK-MB content at 4 and 24 h after surgery was also lower than that in group B (17.33 ± 5.83 vs. 20.38 ± 4.32 U/l; P = 0.048 and 15.79 ± 5.32 vs. 19.10 ± 4.93 U/l; P = 0.030 , resp.). The number of EPCs in peripheral blood and the number of CD184 coexpressed EPCs in group A were higher than those in group B at 1 h before surgery (37.24 ± 25.20 vs. 22.36 ± 12.26/ml; P = 0.034 and 23.38 ± 15.30 vs. 13.12 ± 14.62/ml; P = 0.013 , resp.). In addition, there were no obvious adverse reactions and no 30-day MACEs in both groups during the trial. Conclusion. SYD can reduce PMI and promote the mobilization of EPCs in the perioperative period of elective PCI in patients with UA.

scholarly journals Pharmacological preconditioning by Nicorandil in prevention of ischaemic myocardial injury during an elective percutaneous coronary intervention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Soboleva ◽  
R.V Gostishev ◽  
A.N Rogoza ◽  
T.I Kotkina ◽  
A.N Samko ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Calcium Channel Blockers ◽  
Myocardial Injury ◽  
Coronary Intervention ◽  
Control Group ◽  
Channel Blockers ◽  
Elective Percutaneous Coronary Intervention ◽  
Percutaneous Coronary ◽  
Β Blockers ◽  
Pharmacological Preconditioning

Abstract Introduction Elective percutaneous coronary intervention (PCI) is accompanied by intraoperative ischemic myocardial injury (IIMI) up to 30% of the cases despite successfully performed procedure. Pharmacological preconditioning can prevent IIMI; Nicorandil is considered promising for this purpose. Purpose To study the possibility of pharmacological preconditioning by oral Nicorandil to ptevent ischaemic myocardial injury and 4a type myocardial infarction (MI) in patients with a stable form of coronary artery disease (CAD) before PCI. Material and methods 182 patients with CAD and indications for PCI were randomized into two groups: Nicorandil treatment group (additionally to β-blockers and a calcium channel blockers, n=90) and the control group (β-blockers and a calcium channel blockers, n=92). Nicorandil per os was prescribed 2 days before the PCI (30 mg/day); on the day of PCI – 2 hours before intervention (20 mg), 6–12 hours after PCI – 10 mg. The analysis of hs-Troponin I (hs-Tr) and creatine phosphokinase-MB (CK-MB)was carried out before PCI and 24, 72 hours after the procedure. The diagnosis of MI 4a type was established according to fourth universal definition. Double antiplatelet therapy was prescribed to all patients. Results Clinical profile (age, BMI, BP, creatinin clearance, LDL-cholesterol, glucose) of the patient groups were comparable by the basic parameters. The rate of hs-Tr after 24 hours has approached the 99th percentile from the upper limit of normal in 146 patients (80%). The increment of mean level of hs-Tr 24 hours after PCI has not distinguish statistically between the Nicorandil and the control group (364 vs 725 pg/ml, p=0,1). Mean of CK-MB increment in the control group has approached 2,5 ng/ml vs 0,5 ng/ml in the Nicorandil group (p=0.06). Among women (n=61), the increment of hs-Tr in 24 hours after PCI was statistically significantly lower (287 vs 1135 pg/ml, p=0,04) in the Nicorandil group compared to the control group. MI 4a type was detected in 12% of patients in the control group, and it decreased to 3% of patients in the Nicorandil group (p=0,05), it was observed in 21% in women in the control group and in 3% in the Nicorandil group. Conclusion Nicorandil treatment using before PCI decreases the risk of MI 4a in patients with a stable CAD due to the realization of pharmacological preconditioning. Funding Acknowledgement Type of funding source: None

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