title: Sevoflurane in acute myocardial infarction: a pilot randomized study.
abstract: BACKGROUND
  Experimental evidence suggests that the inhalational anesthetic sevoflurane has a cardioprotective effect. Our objective was to determine if sedation with sevoflurane will reduce infarct size in patients with acute myocardial infarction (MI) who are treated with primary percutaneous coronary intervention (PCI).
  
  
  METHODS
  We randomized 50 patients presenting with a first acute ST-elevation MI treated by primary PCI within 6 hours from symptom onset to sedation with sevoflurane inhalation or standard sedation (control). Coronary flow at the end of PCI was assessed by corrected Thrombolysis In Myocardial Infarction frame count. Myocardial reperfusion was assessed by ST-segment resolution 60 minutes post-PCI. Infarct size was assessed by release of creatinine kinase (CK) and troponin T.
  
  
  RESULTS
  There was no difference in the primary end point: troponin T or CK release adjusted to the area at risk, between groups. However, among patients with anterior MI, there was a trend toward lower CK (P = .05) and nonsignificant decrease in troponin (P = .11) levels in the sevoflurane group. Corrected Thrombolysis In Myocardial Infarction frame count was 12.3 ± 1.5 in the sevoflurane group and 15.6 ± 9.1 in the control group (P = .16). There was more ST resolution in patients treated by sevoflurane 80.7% ± 25.8% versus 56.6% ± 35.7% (P = .01). Sevoflurane had no significant adverse effect during administration.
  
  
  CONCLUSIONS
  Sevoflurane administration during primary PCI did not reduce infarct size. There was a trend toward a reduction in infarct size among patients with anterior MI. Sevoflurane administration was associated with improvement in ST-segment resolution.
authors.affiliation: Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada. Electronic address: shahar.lavi@lhsc.on.ca.
authors.forename: Shahar
authors.initials: S
authors.lastname: Lavi
authors.affiliation: Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Bainbridge
authors.affiliation: London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Sabrina
authors.initials: S
authors.lastname: D'Alfonso
authors.affiliation: Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Pantelis
authors.initials: P
authors.lastname: Diamantouros
authors.affiliation: Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Jaffer
authors.initials: J
authors.lastname: Syed
authors.affiliation: Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada.
authors.forename: George
authors.initials: G
authors.lastname: Jablonsky
authors.affiliation: Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Ronit
authors.initials: R
authors.lastname: Lavi
mesh_terms: D000368:Aged; D018685:Anesthetics, Inhalation / Q000627:therapeutic use*; D056988:Anterior Wall Myocardial Infarction / Q000628:therapy; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D003402:Creatine Kinase / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000627:therapeutic use*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D015425:Myocardial Reperfusion; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010865:Pilot Projects; D012720:Severity of Illness Index; D000077149:Sevoflurane; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood
chemical_list: D018685:Anesthetics, Inhalation; D002316:Cardiotonic Agents; D008738:Methyl Ethers; D020107:Troponin T; D000077149:Sevoflurane; D003402:Creatine Kinase