Ispitivanje učinka trimetazidina na periproceduralno oštećenje miokarda tijekom elektivne perkutane intervencije na nativnim koronarnim arterijama

Margetić, Eduard (2011) Ispitivanje učinka trimetazidina na periproceduralno oštećenje miokarda tijekom elektivne perkutane intervencije na nativnim koronarnim arterijama. PhD thesis, Sveučilište u Zagrebu.

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Abstract

We tested the chronic, oral pretreatment with trimetazidine on the occurrence of periprocedural myocardial injury in patients undergoing elective percutaneous intervention on native coronary artery. For the detection of myocardial lesion we used extremely sensitive marker, cardiac troponin I. Patients were randomized into two subgroups that did not differ in their demographic and clinical characteristics, while the interventional procedure was standardized to mandatory direct stent implantation with a single balloon expansion for the period of 20 seconds. There was no difference among the subgroups given the length and diameter of the stent and a maximum pressure of expansion. Cardiac tropinin I concentrations were determined immediately before and 4, 12, 24 and 48 hours after stent implantation. There were no significant differences between trimetazidine and control subgroups in the samples taken before and 4 hours after PCI. Significant differences were found in samples taken 12 (p = 0,002), 24 (p = 0.020) and 48 (p = 0.029) hours after the procedure. Differences persist until the end of the investigated period. Our results show that taking trimetazidine in a daily dose of 60 mg, for a period of at least 15 days before the elective procedure, significantly reduces the extent of myocardial damage during percutaneous coronary intervention.

Abstract in Croatian

Ispitivan je učinak kronične terapije trimetazidinom na nastanak periproceduralne miokardne ozljede kod bolesnika podvrgnutih elektivnoj perkutanoj intervenciji na nativnoj koronarnoj arteriji. Za detekciju lezije srčanog mišića korišten je izuzetno osjetljivi biljeg, srčani troponin I, Bolesnici su randomizirani u dvije podskupine koje se nisu razlikovale po svojim demografskim i kliničkim karakteristikama, dok je postupak intervencije bio maksimalno standardiziran uz direktnu implantaciju stenta jednokratnom ekspanzijom balona u trajanju od 20 sekundi. Nije postojala razlika među podskupinama obzirom na dužinu i promjer stenta te maksimalni tlak ekspanzije. Koncentracija cTnI određivala se neposredno prije PCI te 4, 12, 24 i 48 sati nakon zahvata. Nisu nađene značajne razlike između trimetazidinske i kontrolne podskupine u uzorcima uzetim prije i 4 sata nakon PCI. Značajne razlike nađene su 12 (p=0.002), 24 (p=0.020) i 48 (p=0.029) sati nakon zahvata. Razlike perzistiraju sve do kraja ispitivanog perioda. Dobiveni rezultati pokazuju da uzimanje trimetazidina u dnevnoj dozi od 60 mg, u periodu od 15 dana prije elektivne intervencije na koronarnoj arteriji, značajno smanjuje oštećenje srčanog mišića tijekom perkutane koronarne intervencije.

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