title: Trimetazidine on ischemic injury and reperfusion in coronary artery bypass grafting.
abstract: BACKGROUND
  The ischemia and reperfusion ischemia is a common physiopathological mechanisms, which has difficult control during Coronary Artery Bypass Grafting (CABG) with cardiopulmonary bypass, the critical moment of which happening by the end of surgery, when there is declamping of aorta and release of hyperoxic radicals causing the injury.
  
  
  OBJECTIVE
  Evaluate, in a randomized double-blind prospective study, controlled with placebo, the effects of Trimetazidine (Tmz) on ischemic injury and myocardial reperfusion, identifying the change in plasma markers of a myocardial aggression (troponin T and CPK-MB), and echocardiographic changes of ventricular function.
  
  
  METHODS
  We studied 60 patients divided in two groups (placebo and Tmz) with mild ventricular dysfunction at the most, stratified by echocardiography and receiving medication/placebo at a dose of 20 mg/3 x/day, starting from 12 to 15 days after pre-operative period up to 5 to 8 days after post-operative period. Troponin T and Cpk-Mb were measured preoperatively without medication, 12 to 15 days of medication/placebo taken five minutes after aortic declamping, and at subsequent 12, 24 and 48 hours.
  
  
  RESULTS
  Both Troponin T and Cpk-Mb reached highly significant values (p = 0.0001) in the treated group compared to the control group at the four moments analyzed--5 min, 12 h, 24 h and 48 h. The echocardiographic variables did not show evolutive changes in each group severally considered and when compared among themselves.
  
  
  CONCLUSIONS
  Trimetazidine was effective in reducing ischemic injury and reperfusion, had no effect on left ventricular function, and no side effects were observed.
authors.affiliation: Instituto Estadual de Cardiologia Aloysio de Castro, RJ. gerezm@cardiol.br
authors.forename: Gerez Fernandes
authors.initials: GF
authors.lastname: Martins
authors.forename: Aristarco Gonçalves de
authors.initials: AG
authors.lastname: Siqueira Filho
authors.forename: João Bosco de Figueiredo
authors.initials: JB
authors.lastname: Santos
authors.forename: Claudio Roberto Cavalcanti
authors.initials: CR
authors.lastname: Assunção
authors.forename: Francisco
authors.initials: F
authors.lastname: Bottino
authors.forename: Káttia Gerúndio de
authors.initials: KG
authors.lastname: Carvalho
authors.forename: Alberto
authors.initials: A
authors.lastname: Valência
mesh_terms: D015415:Biomarkers / Q000097:blood; D001026:Coronary Artery Bypass; D052279:Creatine Kinase, MB Form / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000188:drug therapy*; D015428:Myocardial Reperfusion Injury / Q000097:blood / Q000188:drug therapy*; D015990:Placebo Effect; D011183:Postoperative Complications / Q000097:blood / Q000188:drug therapy*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014292:Trimetazidine / Q000008:administration & dosage / Q000627:therapeutic use*; D020107:Troponin T / Q000097:blood; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D015415:Biomarkers; D020107:Troponin T; D014665:Vasodilator Agents; D052279:Creatine Kinase, MB Form; D014292:Trimetazidine