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Trimetazidine on ischemic injury and reperfusion in coronary artery bypass grafting
Gerez Fernandes Martins1, Aristarco Gonçalves de Siqueira Filho, João Bosco de Figueiredo Santos
1Instituto Estadual de Cardiologia Aloysio de Castro, RJ. gerezm@cardiol.br
Insights
Trimetazidine effectively reduced myocardial injury during coronary artery bypass grafting surgery. This study found no impact on left ventricular function, indicating a safe therapeutic option for reducing ischemia and reperfusion damage.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Pharmacology
Background:
- Ischemia and reperfusion injury are significant challenges during Coronary Artery Bypass Grafting (CABG).
- These injuries often occur during aortic declamping, releasing damaging hyperoxic radicals.
- Effective control of these mechanisms remains a critical aspect of CABG procedures.
Purpose of the Study:
- To evaluate the efficacy of Trimetazidine (Tmz) in mitigating myocardial ischemic and reperfusion injury.
- To assess changes in plasma markers of myocardial aggression, specifically Troponin T and CPK-MB.
- To identify any effects of Trimetazidine on echocardiographic measures of ventricular function.
Main Methods:
- A randomized, double-blind, placebo-controlled study involving 60 patients with mild ventricular dysfunction.
- Patients received either Trimetazidine (20 mg three times daily) or placebo for 12-15 days pre-operatively and 5-8 days post-operatively.
- Plasma Troponin T and CPK-MB levels were measured at multiple time points, including pre-operatively, and at 5 minutes, 12, 24, and 48 hours post-aortic declamping.
Main Results:
- Both Troponin T and CPK-MB levels were significantly lower (p = 0.0001) in the Trimetazidine group compared to the placebo group at all measured time points.
- These significant reductions indicate a substantial decrease in myocardial injury in the treated group.
- No significant changes in echocardiographic variables of left ventricular function were observed within or between the groups.
Conclusions:
- Trimetazidine demonstrated effectiveness in reducing myocardial ischemic and reperfusion injury following CABG.
- The medication did not adversely affect left ventricular function.
- No adverse side effects were reported, suggesting Trimetazidine is a safe intervention for this patient population.
Background:
The ischemia and reperfusion ischemia is a common physiopathological mechanisms, which has difficult control during Coronary Artery Bypass Grafting (CABG) with cardiopulmonary bypass, the critical moment of which happening by the end of surgery, when there is declamping of aorta and release of hyperoxic radicals causing the injury.
Objective:
Evaluate, in a randomized double-blind prospective study, controlled with placebo, the effects of Trimetazidine (Tmz) on ischemic injury and myocardial reperfusion, identifying the change in plasma markers of a myocardial aggression (troponin T and CPK-MB), and echocardiographic changes of ventricular function.
Methods:
We studied 60 patients divided in two groups (placebo and Tmz) with mild ventricular dysfunction at the most, stratified by echocardiography and receiving medication/placebo at a dose of 20 mg/3 x/day, starting from 12 to 15 days after pre-operative period up to 5 to 8 days after post-operative period. Troponin T and Cpk-Mb were measured preoperatively without medication, 12 to 15 days of medication/placebo taken five minutes after aortic declamping, and at subsequent 12, 24 and 48 hours.
Results:
Both Troponin T and Cpk-Mb reached highly significant values (p = 0.0001) in the treated group compared to the control group at the four moments analyzed--5 min, 12 h, 24 h and 48 h. The echocardiographic variables did not show evolutive changes in each group severally considered and when compared among themselves.
Conclusion:
Trimetazidine was effective in reducing ischemic injury and reperfusion, had no effect on left ventricular function, and no side effects were observed.
