1Department of Cardiology, Rajaiee Heart Center, Iran University of Medical Sciences, Tehran, Iran; 2Department of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; 3Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; 4Resident of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Departments of 5Research; 6Epidemiology and Biostatistics, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran; and 7Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
Am J Ther. 2017 Nov/Dec;24(6):e723-e729. doi: 10.1097/MJT.0000000000000411.
Increased accumulation of reactive oxygen species contributes to pathophysiologic states such as endothelial dysfunction, metabolic and functional impairment, inflammatory activation, and other features of cardiovascular pathophysiology. Allopurinol acts as a xanthine oxidase inhibitor that reduces the amount of free radicals after reactive oxygen species generation.
In this placebo-controlled randomized clinical trial, all patients admitted with coronary artery disease who are candidates for elective percutaneous coronary intervention (PCI) were included. The 254 patients were randomly divided into 2 groups. Blood samples for cardiac biomarkers (creatine kinase [CK]-MB and troponin T [cTnT]) were collected from all patients after admission (the day before PCI), and also 8 and 16 hours after intervention. In group 1 (133 patients), 600 mg allopurinol was orally administered on the day before PCI, and another same dose on the day of PCI, and the elective PCI was performed. In group 2 (121 patients), elective PCI was performed without pretreatment with allopurinol. In an unadjusted model, the serum levels of both CK-MB and cTnT, 16 hours after PCI were higher in the placebo group as compared with the allopurinol group, although it was statistically insignificant. We compared the maximum levels of CK-MB and cTnT (8 or 16 hours after PCI) and their maximum changes in both groups. After adjustment for confounders, use of allopurinol did not have any statistically significant association with the rise of cardiac-spec-fic enzymes.
Allopurinol could not be effective significantly, in patients undergoing elective PCI, to decrease cardiac-specific enzymes, and seems not to be of use before PCI.
活性氧物质的积累增加导致了病理生理状态，如内皮功能障碍、代谢和功能障碍、炎症激活以及心血管病理生理学的其他特征。别嘌醇作为黄嘌呤氧化酶抑制剂，可减少活性氧物质产生后自由基的数量。
在这项安慰剂对照随机临床试验中，所有因冠状动脉疾病而入院且适合选择性经皮冠状动脉介入治疗（PCI）的患者均被纳入研究。254 名患者被随机分为两组。所有患者入院后（PCI 前一天）采集血样进行心脏生物标志物（肌酸激酶同工酶 [CK-MB] 和肌钙蛋白 T [cTnT]）检测，并在介入后 8 小时和 16 小时再次采血。在第 1 组（133 例）中，在 PCI 前一天口服 600mg 别嘌醇，在 PCI 当天再次给予相同剂量的别嘌醇，然后进行选择性 PCI。在第 2 组（121 例）中，未进行别嘌醇预处理即进行选择性 PCI。在未调整的模型中，与别嘌醇组相比，安慰剂组 PCI 后 16 小时 CK-MB 和 cTnT 的血清水平更高，但无统计学意义。我们比较了两组的 CK-MB 和 cTnT 的最大水平（PCI 后 8 小时或 16 小时）及其最大变化。在调整混杂因素后，别嘌醇的使用与心脏特异性酶的升高无统计学显著关联。
在接受选择性 PCI 的患者中，别嘌醇不能显著降低心脏特异性酶，且在 PCI 前似乎没有作用。
