Shafaei-Bajestani Negar, Talasaz Azita Hajhossein, Salarifar Mojtaba, Pourhosseini Hamidreza, Sadri Farshad, Jalali Arash
Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Department of Clinical Pharmacy, Faculty of pharmacy, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
J Res Pharm Pract. 2019 Apr-Jun;8(2):75-82. doi: 10.4103/jrpp.JRPP_18_78.
The aim of the present study was to determine the effects of intravenous (IV) and intracoronary administration of Vitamin C on the incidence of periprocedural myocardial injury in patients undergoing primary percutaneous coronary intervention (PCI).
In this prospective, double-blind, randomized clinical trial, that was conducted in Tehran Heart Center, Iran, between October 2016 and March 2017, 252 patients undergoing primary PCI were enrolled to receive either 3 g of IV Vitamin C before PCI and 100 mg of intracoronary Vitamin C during PCI in addition to the routine treatment ( = 126) or just the routine treatment ( = 126). Cardiac biomarkers were measured before and then 6 and 12 h postprocedurally. We determined the occurrence of contrast-induced acute kidney injury (CI-AKI), according to the levels of serum creatinine, neutrophil gelatinase-associated lipocalin, and platelet activation biomarker (P-selectin) in a subset of 119 patients before and 6 h after PCI.
In the patients who received Vitamin C, the serum levels of troponin T after 12 h and creatine kinase-MB after 6 h were significantly lower than those in the placebo group ( = 0.003 andP = 0.00, respectively). CI-AKI occurred in 6 (4.7%) patients in the study group and 8 (6.3%) patients in the control group; there was no significant reduction in CI-AKI in the study group. In addition, the two groups were statically similar as regards the changes in the level of P-selectin.
In primary PCI patients, the prophylactic use of IV and intracoronary Vitamin C can confer additional clinical benefits such as cardioprotection.
本研究旨在确定静脉注射（IV）和冠状动脉内注射维生素C对接受直接经皮冠状动脉介入治疗（PCI）患者围手术期心肌损伤发生率的影响。
在2016年10月至2017年3月于伊朗德黑兰心脏中心进行的这项前瞻性、双盲、随机临床试验中，252例接受直接PCI的患者被纳入研究，除常规治疗外，一组（n = 126）在PCI前接受3 g静脉注射维生素C且在PCI期间接受100 mg冠状动脉内注射维生素C，另一组（n = 126）仅接受常规治疗。在术前以及术后6小时和12小时测量心脏生物标志物。我们根据119例患者PCI术前和术后6小时的血清肌酐、中性粒细胞明胶酶相关脂质运载蛋白和血小板活化生物标志物（P-选择素）水平，确定造影剂诱导的急性肾损伤（CI-AKI）的发生情况。
接受维生素C治疗的患者，12小时后的肌钙蛋白T血清水平和6小时后的肌酸激酶同工酶MB血清水平显著低于安慰剂组（分别为P = 0.003和P = 0.00）。研究组有6例（4.7%）患者发生CI-AKI，对照组有8例（6.3%）患者发生CI-AKI；研究组CI-AKI发生率无显著降低。此外，两组在P-选择素水平变化方面在统计学上相似。
在直接PCI患者中，预防性静脉注射和冠状动脉内注射维生素C可带来额外的临床益处，如心脏保护作用。
