Skip Navigation

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Disclaimer
Right arrow Request Permissions
Google Scholar
Right arrow Articles by Danchin, N.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Danchin, N.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?


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

References

  1. Califf RM, Abdelmeguid AE, Kuntz RE, et al. Myonecrosis after revascularization procedures. J Am Coll Cardiol. 1998;31:241–251[Abstract/Free Full Text]
  2. The ESPRIT investigators. Novel dosing regimen of eptifibatide in planned coronary stent implantation (ESPRIT): a randomised, placebo-controlled trial. Lancet. 2000;356:2037–2044[CrossRef][Web of Science][Medline]
  3. The EPISTENT investigators. Randomised placebo-controlled ans balloon angioplasty trial to assess safety of coronary stenting with use of platelet glycoprotein IIb/IIIa blockade. Lancet. 1998;352:87–92[Web of Science][Medline]
  4. Detry JM, Leclercq JP. Trimetazidine European Multicenter study versus propanolol in stable angina pectoris: contribution of Holter electrocardiographic ambulatory monitoring. Am J Cardiol. 1995;76:8B–11B[CrossRef][Medline]
  5. Sellier P. Chronic effects of trimetazidine on ergometric parameters in effort angina. Cardiovasc Drugs Ther. 1990;4(suppl 4):822–823
  6. Théroux P, Chaitman B, Danchin N, et al, GUARD During Ischemia Against Necrosis (GUARDIAN) investigators. Inhibition of the sodium-hydrogen exchanger with cariporide to prevent myocardial infarction in high-risk ischemic situations. Main results of the GUARDIAN trial. Circulation. 2000;102:3032–3038[Abstract/Free Full Text]
  7. Sodi-Pallares D, Testelli M, Fishleder F. Effects of an intravenous infusion of a potassium-insulin-glucose solution on the electrocardiographic signs of myocardial infarction. Am J Cardiol. 1962;9:166–181[CrossRef][Web of Science][Medline]
  8. Kantor PF, Lucien A, Kozak R, Lopaschuk GD. The antianginal drug trimetazidine shifts cardiac energy metabolism from fatty acid oxidation to glucose oxidation by inhibiting mitochondrial long chain 3-ketoacyl coenzyme A thiolase. Circ Res. 2000;86:580–588[Abstract/Free Full Text]
  9. Juillière Y, Danchin N, Bertrand ME, et al. Cardioprotective effect of intracoronary nifedipine during percutaneous transluminal coronary angioplasty. A French double-blind cross-over multi-centre study. Int J Cardiol. 1993;39:43–48[CrossRef][Web of Science][Medline]
  10. Doorey AJ, Mehmel HC, Schwartz FX, Kübler W. Amelioration by nitroglycerin of left ventricular ischemia induced by percutaneous transluminal coronary angioplasty: assessment by hemodynamic variables and left ventriculaorgraphy. J Am Coll Cardiol. 1985;6:267–274[Abstract]
  11. Zalewski A, Goldberg S, Dervan JP, Slysh S, Maroko PR. Myocardial protection during transient coronary artery occlusion in man: beneficial effects of regional beta-adrenergic blockade. Circulation. 1986;73:734–749[Abstract/Free Full Text]
  12. Timour Q, Harpey C, Durr F, et al. Is the antianginal action of trimetazidine independent of hemodynamic changes? Cardiovasc Drugs Ther. 1991;5:1043–1044[CrossRef][Web of Science][Medline]
  13. Kober G, Buck T, Sievert H, Vallbracht C. Myocardial protection during percutaneous transluminal coronary angioplasty: effects of trimetazidine. Eur Heart J. 1992;13:1109–1115[Abstract/Free Full Text]
  14. Steg PG, Laperche T, Karila-Cohen D. Value of trimetazidine as adjuvant therapy for primary PTCA at the acute stage of myocardial infarction. Eur Heart J. 1999;(suppl O):O19–O23
  15. Rüpprecht HJ, vom Dahl J, Terres W, et al. Cardioprotective effects of the Na+/H+ exchange inhibitor cariporide in patients with acute anterior myocardial infarction undergoing direct PTCA. Circulation. 2000;101:2902–2908[Abstract/Free Full Text]
  16. Lazar HL, Philippides G, Fitzgerld C, Lancaster D, Shemin RJ, Apstein C. Glucose insulin potassium solutions enhance recovery after urgent coronary artery bypass grafting. J Thorac Cardiovasc Surg. 1997;113:354–362[Abstract/Free Full Text]
  17. Girard C, Quentin P, Bouvier H, et al. Glucose and insulin supply before cardiopulmonary bypass in cardiac surgery: a double-blind study. Ann Thorac Surg. 1992;54:259–263[Abstract]
  18. Fabiani JN, Ponzio O, Emerit I, et al. Cardioprotective effect of trimetazidine during coronary artery graft surgery. J Cardiovasc Surg. 1992;33:486–491[Medline]
  19. Tünerir B, Colak O, Alatas O, Besogul Y, Kural T, Aslan R. Measurement of troponin T to detect cardioprotective effect of trimetazidine during coronary artery bypass grafting. Ann Thorac Surg. 1999;68:2173–2176[Abstract/Free Full Text]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?



This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Disclaimer
Right arrow Request Permissions
Google Scholar
Right arrow Articles by Danchin, N.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Danchin, N.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?