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Protective influence of pretreatment with allopurinol on myocardial function in patients undergoing coronary artery
A Bochenek1, Z Religa, T J Spyt
1University Department of Cardiac Surgery, Silesian Medical Academy, Katowice, Poland.
Abstract:
Xanthine oxidase is responsible for the release of free oxygen radicals during myocardial reperfusion. Allopurinol was shown to be an effective inhibitor of this reaction in the laboratory experiments, but not in patients. Thirteen male patients undergoing routine coronary artery bypass graft surgery were treated with allopurinol in doses of 15 mg/kg per day for 4 days before the operation. Haemodynamic function in the early period after cardiopulmonary bypass, ECG, enzyme release and ultrastructural findings in this group were compared with those in a control group of 13 male patients matched for age distribution and stage of coronary disease. Left ventricular stroke work index was higher in the treatment group 10 min (P less than 0.001) and 15 min after termination of cardiopulmonary bypass (P less than 0.01) and also 2 h later (P less than 0.02). In the early post-operative recovery phase fewer episodes of arrhythmia were observed in this group of patients (P less than 0.001). Electron microscopy studies of the myocardium and CK and CK-MB release showed no significant differences between groups. Thus, allopurinol may have a protective effect on the human ischaemic myocardium in the early period of reperfusion.
Insights
Allopurinol demonstrated a protective effect on the human ischemic myocardium during reperfusion, improving hemodynamic function and reducing arrhythmias in patients undergoing bypass surgery.
Area of Science:
- Cardiology
- Pharmacology
- Biochemistry
Background:
- Xanthine oxidase generates oxygen radicals during myocardial reperfusion.
- Allopurinol inhibits xanthine oxidase in vitro but has shown limited efficacy in patients.
- Myocardial reperfusion injury is a significant concern in cardiac surgery.
Purpose of the Study:
- To evaluate the efficacy of allopurinol in protecting the human ischemic myocardium during coronary artery bypass graft surgery.
- To assess the impact of allopurinol on hemodynamic function, arrhythmias, and myocardial damage markers.
Main Methods:
- A randomized controlled trial involving 26 male patients undergoing coronary artery bypass graft surgery.
- 13 patients received allopurinol (15 mg/kg/day for 4 days pre-operatively); 13 served as controls.
- Hemodynamic parameters, ECG, enzyme release (CK, CK-MB), and ultrastructural myocardial findings were compared.
Main Results:
- The allopurinol group showed a significantly higher left ventricular stroke work index post-bypass (P < 0.001 to P < 0.02).
- Fewer episodes of arrhythmia were observed in the allopurinol group during early recovery (P < 0.001).
- No significant differences were found in myocardial ultrastructure or enzyme release between groups.
Conclusions:
- Allopurinol may offer a protective effect on the human ischemic myocardium in the early reperfusion period after cardiac surgery.
- The drug improved hemodynamic stability and reduced arrhythmias, suggesting a clinical benefit despite no changes in biochemical markers.
- Further research is warranted to elucidate the precise mechanisms and optimize allopurinol's use in cardiac patients.