Journal Article

Recent advances in cardioprotection during myocardial revascularization procedures: benefit of a metabolic intervention

N. Danchin

in European Heart Journal Supplements

Published on behalf of European Society of Cardiology

Volume 3, issue suppl_O, pages O21-O25
Published in print November 2001 | ISSN: 1520-765X
Published online November 2001 | e-ISSN: 1554-2815 | DOI: http://dx.doi.org/10.1016/S1520-765X(01)90151-8
Recent advances in cardioprotection during myocardial revascularization procedures: benefit of a metabolic intervention

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Among agents that can act directly on myocyte metabolism in order to ensure myocardial protection during revascularization procedures, trimetazidine is already available because of its anti-ischaemic properties in patients with angina pectoris, whereas others are still under investigation. In elective coronary angioplasty, trimetazidine delays ST-segment shift and reduces its extent by more than 40% during balloon inflation as compared with placebo. In the GUARD During Ischaemia Against Necrosis (GUARDIAN) trial, cariporide, an inhibitor of the sodium-hydrogen exchanger, had no effect on death or myocardial infarction. With regard to primary angioplasty for acute myocardial infarction, both the Limitation of Infarct Size by Trimetazidine (LIST) study and a trial that employed cariporide showed that metabolic intervention before angioplasty had favourable effects. Regarding coronary surgery, in the GUARDIAN trial, high-dose cariporide was associated with fewer cardiac events. Likewise, during coronary surgery, patients who were pretreated with trimetazidine exhibited lesser release of markers of myocardial injury. Therefore, metabolic intervention appears a promising way to lessen myocardial injury associated with revascularization procedures. Its long-term benefit, however, should be studied in large-scale therapeutic trials.

Keywords: Cariporide; coronary angioplasty; coronary bypass surgery; glucose-insulin-potassium; myocardial protection; trimetazidine

Journal Article.  0 words. 

Subjects: Cardiovascular Medicine

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