Journal
HEART
Volume 100, Issue 7, Pages 544-549Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/heartjnl-2013-304845
Keywords
Cardiac Surgery; Myocardial Ischaemia and Infarction (IHD)
Categories
Funding
- British Heart Foundation [RG/03/007, FS/10/039/28270, FS/10/72/28568]
- RoseTree Trust
- National Institute for Health Research University College London Hospitals Biomedical Research Centre
- NIHR CLRN
- Department of Research and Development, King's College Hospital Foundation Trust, London
- British Heart Foundation [FS/10/72/28568, RG/08/015/26411] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0510-10164] Funding Source: researchfish
- Rosetrees Trust [M274] Funding Source: researchfish
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Objective Cyclosporin-A (CsA) has been reported to reduce myocardial infarct size in both the experimental and clinical settings. This protective effect is dependent on its ability to prevent the opening of the mitochondrial permeability transition pore, a critical determinant of cell death in the setting of acute ischaemia-reperfusion injury. Whether CsA can reduce the extent of peri-operative myocardial injury (PMI) in patients undergoing coronary artery bypass graft (CABG) surgery is unknown, and is investigated in this randomised controlled clinical trial. Methods 78 adult patients undergoing elective CABG surgery were randomised to receive either an intravenous bolus of CsA (2.5mg/kg) or placebo administered after induction of anaesthesia and prior to sternotomy. PMI was assessed by measuring serum cardiac enzymes, troponin T (cTnT) and CK-MB at 0, 6, 12, 24, 48 and 72h after surgery. Results There was no significant difference in mean peak cTnT levels between control (n=43) and CsA treatment (n=40) patients (0.560.06ng/mL with control vs 0.35 +/- 0.05ng/mL with CsA; p=0.07). However, in higher-risk patients with longer cardiopulmonary bypass times, there was a significant reduction in PMI with CsA therapy (p=0.049), with a reduced postoperative cTnT rise by 0.03ng/mL for every 10min, when compared with control. Conclusions In patients with longer cardiopulmonary bypass times, a single intravenous bolus of CsA administered prior to CABG surgery reduced the extent of PMI.
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