Trimetazidine and inflammatory response in coronary artery bypass grafting.
BACKGROUND
Organic inflammatory response is a pathophysiological mechanism present at every coronary artery bypass grafting with extracorporeal circulation (CABG-ECC), the release of inflammatory mediators being one of its defense mechanisms.


OBJECTIVE
To assess, in a prospective double-blind randomized and placebo-controlled study, the effects of trimetazidine (Tmz) on the inflammatory response, by using the variation in interleukins 6 and 8, TNF-α, complements C3 and C5, and highly sensitive C-reactive protein (HS-CRP) levels in the pre- and post-operative periods.


METHODS
This study assessed 30 patients undergoing CABG-ECC with intermittent hypothermic cardioplegia, and having, at most, mild ventricular dysfunction. The patients were divided into two groups (placebo and Tmz), stratified by echocardiography, and received drug/placebo at the dose of 60 mg/day. Measurements were taken as follows: in the pre-operative period with no drug; on the day of surgery, corresponding to 12 to 15 days on drug/placebo; five minutes after aortic unclamping; 12 and 24 hours after surgery, for interleukins and complements; and 48 hours after surgery, for HS-CRP.


RESULTS
No significant difference between the levels of interleukin 8, TNF-α, C3 and C5, and HS-CRP was observed. However, the interleukin 6 levels were significantly lower in the group treated as compared with those in the control group at all time points assessed.


CONCLUSIONS
Trimetazidine proved to be effective only for reducing interleukin 6 in patients undergoing CABG.
Instituto de Cardiologia Aloysio de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil. gerezm@cardiol.br
Gerez Fernandes
GF
Martins
Aristarco Gonçalves de
AG
Siqueira Filho
João Bosco de Figueiredo
JB
Santos
Claudio Roberto Cavalcanti
CR
Assunção
Francisca Bottino
FB
Vieira
Alberto
A
Valência
Káttia Gerúncio de
KG
Carvalho
Barbara
B
Jessen
D000368:Aged; D015415:Biomarkers / Q000097:blood; D001026:Coronary Artery Bypass / Q000379:methods*; D016207:Cytokines / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007249:Inflammation / Q000378:metabolism; D018836:Inflammation Mediators / Q000378:metabolism; D008297:Male; D010919:Placebos / Q000008:administration & dosage; D011184:Postoperative Period; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014292:Trimetazidine / Q000008:administration & dosage*; D014665:Vasodilator Agents / Q000008:administration & dosage*
D015415:Biomarkers; D016207:Cytokines; D018836:Inflammation Mediators; D010919:Placebos; D014665:Vasodilator Agents; D014292:Trimetazidine