Trimetazidine Effects on Neutrophils Count in Patients Post PPCI
Abstract
The incidence rate of ST-Elevation acute Myocardial Infarct (STEMI) keeps increasing. Currently, myocardial reperfusion, either with thrombolytic or Primary Percutaneous Coronary Intervention (PPCI), is the main treatment. However, mortality rate of STEMI patients undergoing PPCI is still high which is 6% to 14%. The main purpose of PPCI is to restore the patency of infarcted epicardial artery and to establish microvascular reperfusion as soon as possible so that it can reduce enlargement of irreversible necrotic myocardial tissue. In the other hand, restored patency of infarcted epicardial artery does not indicate sufficient reperfusion to microvascular. Such phenomenon is called no-reflow or microvascular obstruction (MVO). Specific pathogenic component of MVO is reperfusion injury. Reperfusion injury involves some mediator and mechanisms, one of which is the process of thrombolysis and angioplasty. Mediator that play a certain role is inflammatory neutrophil which is activated and accumulated. Trimetazidine is an anti-ischemic agent which selectively inhibits end stage activation of oxidation pathway of 3-ketoacyl coenzyme Athiolase. Trimetazidine has an ability to reduce the accumulation of neutrophilDownloads
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References
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Tabel 1. Perbandingan antara initial perfusion defect, final infarction size dan myocardial salvage index pada kedua kelompok pasien dengan TIMI 3 flow. 18
Group 1 Group 2 P value
Initial perfusion defect 28.5±12.2 25.11±15.4 P = NS
Mean ± SD
Final infarction size 16.25±9.6 17.44±11.5
Mean ± SD
Salvage index 38.32±26.6 28.09±27.9
Mean ± SDand Left Ventricular Remodeling in Reperfused Anterior Wall Myocardial Infarction. Circulation 1996;93:223-8.
6. Ronen Jaffe TC, Geoffrey Puley,Alexander Dick,Bradley H. Strauss. Microvascular Obstruction and the No - Reflow Phenomenon After Percutaneous Coronary Intervention. Circulation 2008;117:3152-6.
7. Subodh Verma PWMF, Richard D Weisel, Jagdish Butany, Vivek Rao, Andrew Maitland, et al. Fundamentals of Reperfusion Injury for the Clinical Cardiologist. Circulation 2002;105:2332-6.
8. James E. Jordan Z-QZ, Jakob Vinten-Johansen. The role of neutrophils in myocardial ischemia – reperfusion injury. Cardiovascular Research 1999;43:860-78.
9. Sheng Kang YY. Coronary microvascular reperfusion injury and no-reflow in acute myocardial infarction. Clin Invest Med 2007;30(3): E133-E45.
10. Vinten-Johansen J. Involvement of neutrophils in the pathogenesis of lethal myocardial reperfusion injury. Cardiovascular Research 2004;61:481-97.
11. Onay-Besikci A, Ozkan SA. Trimetazidine revisited: a comprehensive review of the pharmacological effects and analytical techniques for the determination of trimetazidine. Cardiovasc Ther 2008;26:147-65.
12. Group TE-F. Effect of 48-h intravenous trimetazidine on short-and long-term outcomes of patients with acute myocardial infarction,with and without thrombolytic therapy. European Heart Journal 2000;21:1537-46.
13. Paul F. Kantor AL, Raymond Kozak, Gary D. Lopaschuk. The Antianginal Drug Trimetazidine Shifts Cardiac Energy Metabolism From Fatty Acid Oxidation to Glucose Oxidation by Inhibiting Mitochondrial Long-Chain 3-Ketoacyl Coenzyme A Thiolase. Circulation Research 2000;86:580-8.
14. Opie LH. Preconditioning and metabolic anti-ischaemic agents. European Heart Journal 2003;24:1854-6.
15. F.M Williams KT, M.Kus, T.J Wiliam. Trimetazidine inhibits neutrophil accumulation after myocardial ischemia and reperfusion in rabbits. Journal of Cardiovascular pharmacology 1993;22:828-33.
16. Belcher PR, Drake-Holland AJ, Hynd JW, Noble MI. Effects of trimetazidine on in vivo coronary arterial platelet thrombosis. Cardiovasc Drugs Ther 1993;7:149-57.
17. Ingo Eitel SD, Georg Fuernau, Lysann Hildebrand, Matthias Gutberlet, Gerhard Schuler,et al. Prognostic Significance and Determinants of Myocardial Salvage Assessed by Cardiovascular Magnetic Resonance in Acute Reperfused Myocardial Infarction. Journal American of Cardiologi 2010;55:2470-9.
18. Foad Khaled EA, Bastawy Islam,Khaled Saeed. Effect of trimetazidine on myocardial salvage index in patients with acute ST segment elevation myocardial infarction undergoing primary PCI. The Egyptian Heart Journal 2013;65:181-9.
2. Lori Mandelzweig AB, Valentina Boyko,Hector Bueno,Nicolas Danchin,Gerasimos Filippatos,et al. The second Euro Heart Survey on acute coronary syndromes : characteristics,treatment,and outcome of patients with ACS in Europe and the Mediterranean Basinin 2004. European Heart Journal 2006.
3. Giampaolo Niccoli FB, Leonarda Galiuto,Filippo Crea. Myocardial No-Reflow in Humans. Journal American College of Cardiology 2009;54:281-92.
4. Hiroshi Ito TT, Noriko Sakai,Hisahiro Yu, Yorihiko Higashino, Kenshi Fujii. Lack of Myocardial Perfusion Immediately After Successful Thrombolysis A Predictor of Poor Recovery of Left Ventricular Function in Anterior Myocardial Infarction. Circulation 1992;85:1699-705.
5. Hiroshi Ito AM, Katsuomi Iwakura,Shin Takiuchi,Tohru Masuyama, Masatsugu Hori, et al. Clinical Implications of the ‘No Reflow’ Phenomenon A Predictor of Complications
Tabel 1. Perbandingan antara initial perfusion defect, final infarction size dan myocardial salvage index pada kedua kelompok pasien dengan TIMI 3 flow. 18
Group 1 Group 2 P value
Initial perfusion defect 28.5±12.2 25.11±15.4 P = NS
Mean ± SD
Final infarction size 16.25±9.6 17.44±11.5
Mean ± SD
Salvage index 38.32±26.6 28.09±27.9
Mean ± SDand Left Ventricular Remodeling in Reperfused Anterior Wall Myocardial Infarction. Circulation 1996;93:223-8.
6. Ronen Jaffe TC, Geoffrey Puley,Alexander Dick,Bradley H. Strauss. Microvascular Obstruction and the No - Reflow Phenomenon After Percutaneous Coronary Intervention. Circulation 2008;117:3152-6.
7. Subodh Verma PWMF, Richard D Weisel, Jagdish Butany, Vivek Rao, Andrew Maitland, et al. Fundamentals of Reperfusion Injury for the Clinical Cardiologist. Circulation 2002;105:2332-6.
8. James E. Jordan Z-QZ, Jakob Vinten-Johansen. The role of neutrophils in myocardial ischemia – reperfusion injury. Cardiovascular Research 1999;43:860-78.
9. Sheng Kang YY. Coronary microvascular reperfusion injury and no-reflow in acute myocardial infarction. Clin Invest Med 2007;30(3): E133-E45.
10. Vinten-Johansen J. Involvement of neutrophils in the pathogenesis of lethal myocardial reperfusion injury. Cardiovascular Research 2004;61:481-97.
11. Onay-Besikci A, Ozkan SA. Trimetazidine revisited: a comprehensive review of the pharmacological effects and analytical techniques for the determination of trimetazidine. Cardiovasc Ther 2008;26:147-65.
12. Group TE-F. Effect of 48-h intravenous trimetazidine on short-and long-term outcomes of patients with acute myocardial infarction,with and without thrombolytic therapy. European Heart Journal 2000;21:1537-46.
13. Paul F. Kantor AL, Raymond Kozak, Gary D. Lopaschuk. The Antianginal Drug Trimetazidine Shifts Cardiac Energy Metabolism From Fatty Acid Oxidation to Glucose Oxidation by Inhibiting Mitochondrial Long-Chain 3-Ketoacyl Coenzyme A Thiolase. Circulation Research 2000;86:580-8.
14. Opie LH. Preconditioning and metabolic anti-ischaemic agents. European Heart Journal 2003;24:1854-6.
15. F.M Williams KT, M.Kus, T.J Wiliam. Trimetazidine inhibits neutrophil accumulation after myocardial ischemia and reperfusion in rabbits. Journal of Cardiovascular pharmacology 1993;22:828-33.
16. Belcher PR, Drake-Holland AJ, Hynd JW, Noble MI. Effects of trimetazidine on in vivo coronary arterial platelet thrombosis. Cardiovasc Drugs Ther 1993;7:149-57.
17. Ingo Eitel SD, Georg Fuernau, Lysann Hildebrand, Matthias Gutberlet, Gerhard Schuler,et al. Prognostic Significance and Determinants of Myocardial Salvage Assessed by Cardiovascular Magnetic Resonance in Acute Reperfused Myocardial Infarction. Journal American of Cardiologi 2010;55:2470-9.
18. Foad Khaled EA, Bastawy Islam,Khaled Saeed. Effect of trimetazidine on myocardial salvage index in patients with acute ST segment elevation myocardial infarction undergoing primary PCI. The Egyptian Heart Journal 2013;65:181-9.
Published
2015-12-04
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How to Cite
Mehi, T., Yuniadi, Y., & Haryono, N. (2015). Trimetazidine Effects on Neutrophils Count in Patients Post PPCI. Indonesian Journal of Cardiology, 36(1), 38-45. https://doi.org/10.30701/ijc.v36i1.441
Section
Review Article
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