The Preventive Effect Of Trimetazidine On Contrast-induced Nephropathy In Elderly Patients With Coronary Heart Disease Undergoing Percutaneous Coronary Intervention

Objective:To deplore the preventive effect of trimetazidine on contrast-induced nephropathy(CIN)in elderly patients with coronary heart disease underwent percutaneous coronary intervention(PCI).Method:240 elderly patients with coronary heart disease who underwent PCI in the Department of Cardiology,Tianjin Chest Hospital,from January 2018 to December2019 were randomly divided into control group(120 cases)and trimetazidine group(120 cases).Both groups were treated with 0.9% sodium chloride hydration 12 hours before operation and 12 hours after operation.Trimetazidine group was given 20 mg trimetazidine orally one day before PCI and three days after PCI,and the control group was given hydration only three times a day.The changes of serum creatinine(Scr),blood urea nitrogen(BUN),glomerular filtration rate(e GFR),cystatin C(Cys-C),hypersensitive C-reactive protein(hs-CRP)and malondialdehyde(MDA)were observed before and 48 and 72 hours after PCI.The incidence of CIN and major adverse events in hospital were recorded.Results:1.There were no difference in the levels of Scr,BUN,e GFR,Cys-C,hs-CRP and MDA between the two groups before operation(P > 0.05).2.At 48 h and 72 h after PCI,there was no significant difference in Scr,Cys-C and e GFR levels between trimetazidine group and control group(P > 0.05).3.At 48 and 72 hours after operation,the levels of hs-CRP and MDA in the two groups were significantly higher than those before operation(P < 0.05).4.At 48 and 72 hours after operation,the levels of hs-CRP and MDA in trimetazidine group were lower compared with control group(P< 0.05).5.The incidence of CIN was 5.0% in trimetazidine group and 5.8% in control group,with no significant difference(P > 0.05,χ2 = 0.081).6.Multivariate logistic regression analysis showed that trimetazidine was notan independent protective factor for CIN(OR = 0.329,95% CI: 0.425-4.549,P =0.586).There was no significant difference in the incidence of major adverse events between the two groups during hospitalization(3.3% vs.4.2%,2 = 0.115,P > 0.05).Conclusion :1.Contrast agent may dereat kidney damage and dereat CIN through inflammation and oxidative stress.2.Oral trimetazidine therapy during perioperative period may not effectively decrease the incidence of CIN in elderly patients with CHD underwent PCI.3.Trimetazidine has good drug safety.