Aprotinin decreases ischemic damage during coronary revascularization.
OBJECTIVE
This study sought to determine whether the favorable anti-inflammatory effects of aprotinin might limit ischemic damage during the revascularization of ischemic myocardium.


METHODS
Twenty pigs underwent 90 minutes of coronary occlusion followed by 45 minutes of blood cardioplegic arrest and 180 minutes of reperfusion. Ten animals received a loading dose of aprotinin (40,000 kallikrein inhibiting units/kg) during the start of coronary occlusion followed by an infusion of 20,000 kallikrein inhibiting units/kg/hour. Ten other animals received no aprotinin. Summary statistics are expressed as the mean +/- standard error.


RESULTS
The aprotinin-treated animals required less cardioversions for ventricular arrhythmias (1.0 +/- 0.7 vs. 3.6 +/- 0.6; p < 0.001), accumulated less lung water (1.0 +/- 0.2% change vs. 6.2 +/- 0.9% change; p = 0.038), had more complete coronary relaxation to bradykinin (34.1 +/- 5.9% change vs. 9.2 +/- 3.5% change; p = 0.01), and had reduced infarct size (area necrosis/area risk = 20 +/- 1.1% vs. 39 +/- 1.2%; p = 0.003).


CONCLUSIONS
Aprotinin limits ischemic injury during acute coronary revascularization by decreasing ventricular arrhythmias and lung edema, preserving endothelial function, and minimizing myocardial necrosis.
Lazar
Harold L
HL
Department of Cardiothoracic Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts 02118, USA. harold.lazar@bmc.org.
Bao
Yusheng
Y
Tanzillo
Leslie
L
O'Gara
Paul
P
Reardon
Deborah
D
Price
David
D
Crowley
Richard
R
Cabral
Howard J
HJ
D000818:Animals; D007611:Aprotinin / Q000494:pharmacology* / Q000627:therapeutic use; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D004195:Disease Models, Animal; D004730:Endothelium, Vascular / Q000187:drug effects / Q000503:physiopathology; D015633:Extravascular Lung Water / Q000187:drug effects; D017682:Myocardial Stunning / Q000209:etiology / Q000517:prevention & control*; D015842:Serine Proteinase Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D013552:Swine; D014664:Vasodilation / Q000187:drug effects
D015842:Serine Proteinase Inhibitors; D007611:Aprotinin