Intravenous ascorbic acid infusion improves myocardial perfusion grade during elective percutaneous coronary intervention: relationship with oxidative stress markers.
OBJECTIVE
Our goal was to explore whether antioxidant vitamin C infusion is able to affect the microcirculation perfusion in patients undergoing elective percutaneous coronary intervention for stable angina.


BACKGROUND
Periprocedural myocardial injury in the setting of elective percutaneous coronary intervention is associated with increased risk of death, recurrent infarction, and revascularization at follow-up. Despite excellent epicardial blood flow, impaired microcirculatory reperfusion may persist and increases the risk of vascular recurrences. Post-percutaneous coronary intervention induced-oxidative stress is one of the potential mechanisms accounting for impaired perfusion.


METHODS
Fifty-six patients were enrolled in a prospective, single-center, randomized study comparing 1 g vitamin C infusion (16.6 mg/min, over 1 h before percutaneous coronary intervention) versus placebo.


RESULTS
At the baseline, Thrombolysis In Myocardial Infarction (TIMI) myocardial perfusion grade <2 was observed in 89% and in 86% of patients randomized to the placebo or vitamin C infusion group, respectively (p > 0.05). After percutaneous coronary intervention, these percentages decreased in the placebo group (32%) and in greater measure in the vitamin C group (4%, p < 0.01). Complete microcirculatory reperfusion (TIMI myocardial perfusion grade = 3) was achieved in 79% of the vitamin C-treated group compared with 39% of the placebo group (p < 0.01); 8-hydroxy-2-deoxyguanosine (p < 0.002) and 8-iso-prostaglandin F(2alpha) (p < 0.02) plasma levels significantly increased in the placebo group while they were significantly reduced in the vitamin C-treated group (p < 0.0001). TIMI myocardial perfusion grade changes from the baseline showed significant correlation with 8-hydroxy-2-deoxyguanosine (p < 0.006) or 8-iso-prostaglandin F(2alpha) (p < 0.01) plasma levels changes.


CONCLUSIONS
In patients undergoing elective percutaneous coronary intervention, impaired microcirculatory reperfusion is improved by vitamin C infusion suggesting that oxidative stress is implicated in such a phenomenon.
Basili
Stefania
S
Department of Experimental Medicine, University of Rome La Sapienza, Rome, Italy.
Tanzilli
Gaetano
G
Mangieri
Enrico
E
Raparelli
Valeria
V
Di Santo
Serena
S
Pignatelli
Pasquale
P
Violi
Francesco
F
D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris; D015906:Angioplasty, Balloon, Coronary; D000975:Antioxidants / Q000008:administration & dosage / Q000627:therapeutic use*; D001205:Ascorbic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D015415:Biomarkers; D017558:Elective Surgical Procedures; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007249:Inflammation / Q000503:physiopathology; D008297:Male; D008833:Microcirculation / Q000187:drug effects; D008875:Middle Aged; D015999:Multivariate Analysis; D015425:Myocardial Reperfusion; D018384:Oxidative Stress; D013223:Statistics as Topic; D013318:Stroke Volume; D016277:Ventricular Function, Left
D000975:Antioxidants; D015415:Biomarkers; D001205:Ascorbic Acid