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

N. Danchin*

Hôpital Européen Georges Pompidou, Paris, France

* Correspondence: Professor Nicolas Danchin, Hôpital Européen Georges Pompidou, Department of Cardiology, 20 rue Leblanc, 75015 Paris, France.

Abstract

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.

Key Words: Cariporide • coronary angioplasty • coronary bypass surgery • glucose-insulin-potassium • myocardial protection • trimetazidine


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