Molecular and Clinical Pharmacology Program, Faculty of Medicine, Campus Norte, Institute of Biomedical Sciences, University of Chile, Avda. Independencia 1027, Santiago 8380000, Chile.
University of Chile Clinical Hospital, Campus Norte, Carlos Lorca Tobar 999, Independencia, Santiago 8380456, Chile.
Molecules. 2021 Sep 21;26(18):5702. doi: 10.3390/molecules26185702.
Percutaneous coronary intervention (PCI) has long remained the gold standard therapy to restore coronary blood flow after acute myocardial infarction (AMI). However, this procedure leads to the development of increased production of reactive oxygen species (ROS) that can exacerbate the damage caused by AMI, particularly during the reperfusion phase. Numerous attempts based on antioxidant treatments, aimed to reduce the oxidative injury of cardiac tissue, have failed in achieving an effective therapy for these patients. Among these studies, results derived from the use of vitamin C (Vit C) have been inconclusive so far, likely due to suboptimal study designs, misinterpretations, and the erroneous conclusions of clinical trials. Nevertheless, recent clinical trials have shown that the intravenous infusion of Vit C prior to PCI-reduced cardiac injury biomarkers, as well as inflammatory biomarkers and ROS production. In addition, improvements of functional parameters, such as left ventricular ejection fraction (LVEF) and telediastolic left ventricular volume, showed a trend but had an inconclusive association with Vit C. Therefore, it seems reasonable that these beneficial effects could be further enhanced by the association with other antioxidant agents. Indeed, the complexity and the multifactorial nature of the mechanism of injury occurring in AMI demands multitarget agents to reach an enhancement of the expected cardioprotection, a paradigm needing to be demonstrated. The present review provides data supporting the view that an intravenous infusion containing combined safe antioxidants could be a suitable strategy to reduce cardiac injury, thus improving the clinical outcome, life quality, and life expectancy of patients subjected to PCI following AMI.
经皮冠状动脉介入治疗（PCI）长期以来一直是急性心肌梗死（AMI）后恢复冠状动脉血流的金标准治疗方法。然而，该手术会导致活性氧（ROS）的产生增加，这会加剧 AMI 引起的损伤，特别是在再灌注阶段。基于抗氧化治疗的大量尝试旨在减少心脏组织的氧化损伤，但这些尝试都未能为这些患者提供有效的治疗方法。在这些研究中，迄今为止，使用维生素 C（Vit C）的研究结果尚无定论，这可能是由于研究设计不佳、误解和临床试验的错误结论。然而，最近的临床试验表明，在 PCI 之前静脉输注 Vit C 可降低心脏损伤生物标志物、炎症生物标志物和 ROS 的产生。此外，左心室射血分数（LVEF）和舒张末期左心室容积等功能参数的改善呈趋势，但与 Vit C 无明确关联。因此，通过与其他抗氧化剂联合使用，这些有益作用似乎可以进一步增强，这似乎是合理的。事实上，AMI 中发生的损伤机制的复杂性和多因素性质要求使用多靶点药物来增强预期的心脏保护作用，这一范例需要得到证明。本综述提供的数据支持这样一种观点，即含有联合使用的安全抗氧化剂的静脉输注可能是一种降低心脏损伤的合适策略，从而改善接受 PCI 治疗的 AMI 患者的临床结局、生活质量和预期寿命。
