The effects of postoperative Trimetazidine treatment on ishaemia-reperfusion injury after isolated surgical myocardial revascularisation

Abstract

Abstract Background: The gold standard in managing patients with multi-vessel coronary artery disease (CAD) remains the surgical myocardial revascularization or coronary artery bypass grafting (CABG). Well-known, and described in details, is the pathophysiological process of free radical release in circulation, as a result of increased oxidative stress during the ischemia-reperfusion time and post surgical revascularization procedures. This process could reversibly or irreversibly cause marked myocardial damage. The focus of the present trial, which is prospective single-blinded, controlled and randomised, is on detecting and analysing the trimetazidine drug effect on decreasing postoperative ischaemia-reperfusion myocardial damage. The aim is the evaluation of trimetazidine effects on reactive oxygen species (ROS), which may appear after myocardial ischemia-reperfusion period or systemic inflammatory response after on-pump surgical revascularization. Methods: The present study included 90 elective surgery patients, operated through a time frame from March 2018 till October 2018. The studied population was further divided into two subgroups of comparison. The patients of the first subgroup received regular therapy of trimetazidine 35 mg b.d., immediately after tracheal extuba+tion. The rest of the prescribed medical therapy was standard and identical to all the participants of the studied patient population. Pre-and postoperative levels of specific blood biomarkers such as: high-sensitivity troponin T (hs-TnT), creatinine kinase-MB fraction (CK-MB) and malondialdehyde (MDA) were evaluated. The data was analysed and classified at the time of sample collection. Results: The retrieved data information analysis concluded that regular drug therapy with trimetazidine leads to less malondialdehyde (MDA) release, consequently reduction in oxidative stress and improved cardiomyocyte protection by augmentation of the antioxidant status. The follow-up period was extended and conducted up to 6 months after the surgical revascularization. Excellent results were documented by conducting the Quality of life assessment by Minnesota Living with Heart Failure Questionnaire. Conclusions: Improvement of myocardial cell metabolism and decreasing the level of postoperative ischemia-reperfusion damage is alleviated by postoperative regular trimetazidine drug therapy.