The Effect Of Trimetazidine On Serum Level Of CTnI,hs-CRP And MDA In Patients With CHD Before And After PCI

Background Percutaneous coronary intervention is an effective treatment with high frequency of success at a short time, which could relieve symptom, improve quality of life and prognosis. However, some patients can't benefit from this procedure because of high frequence of early or late-major adverse coronary events. It is more likely to be strongly related to microcirculation dysfunction and injury of ischemic myocardium after PCI. So we hope that there has been some medicine to intervention before PCI which could improve microcirculation function and decrease ischemic myocardium injury so as to improve prognosis.Objective The purpose of this research is to study the effect of trimetazidine on CTFC, the level of cTnI, hs-CRP and MDA in patients with coronary heart disease after PCI. We investigate the effect of trimetazidine and its protective mechanism after PCI.Methods 42 consecutive patients who undergoing elective PCI for coronary heart disease at our center from January to April 2009 were included into this study,including 27 male and 14 female. The research applied synchronization parallel antithesis and self-cross-reference cohort study. 42 patients with UA were randomized into two groups: 21 cases in Group A were orally administrated trimetazidine 20mg tid three day before operation. 21 cases in Group B are treated as control group with routine treatment. The same basic treatments, such as anticoagulation, ?-blocker and angiotensin converting enzyme inhibitors were applied in the two groups. We record CTFC before and after recanalization .Serum levels of hs-CRP, cTnI, MDA were measured before PCI, 1 hour, 6 hours, 12 hours and 24 hours after the procedure. Results1. The CTFC was significantly lower in the trimetazidine group than the control group(p <0.05).2. There was no significant difference in cardiac troponin I(cTnI) before PCI between two groups(p >0.05); The level of cTnI in two groups at 12 hours and 24 hour after PCI were higher significantly instantly than before PCI(p <0.05). and there was significant difference between two groups at 12 hours and 24 hour after PCI, the elevated cTnI value was significantly lower in the trimetazidine group than in the contral group(p <0.05).3. The number of patients with elevated cTnI was more in the contral group than in the trimetazidine group, but they were no significantly difference between two groups(p >0.05).4. The hs-CRP level was similar in both the trimetazidine and cotral groups, hs-CRP level at 24 hour post-PCI point was higher than baseline level, but there was no difference between two groups(p <0.05).5. There was no significant difference in MDA between two groups before PCI(p >0.05); MDA was significantly increase in two groups at each time point post-PCI compared to pre-PCI(p <0.05), and it was higher in the cotral group than in the trimetazidine group at 12h, 24h two points post-PCI (p <0.05).Conclusions1. Trimetazidine can limit the post-PCI cTnI release and decrease the CTFC after PCI, which indicated that trimetazidine may reduce injury of ischemic myocardium and improve microcirculation function.2. Trimetazidine could reduce the elevated MDA post-PCI, which indicate it may limit oxygen free radical produced so as to limit lipid peroxidation limit cardiomyocte apoptosis.3. Trimetazidine administered before PCI may relieve inflammatory reaction induced by reperfusion, limit oxygen free radical produced and have anti-oxidant effect, which appears to be a cardioprotective agent for the prevettion of myocardioal ischaemia.