Abstract:

Objectives: This prospective, randomised, controlled, clinical study was planned to determine the effect of trimetazidine and glucose - insulin - potassium (GIK) on myocardial ischemia-rep­erfusion during beating heart coronary artery bypass surgery. Materials and methods: Patients (n=45) with coronary artery disease who required beating heart coronary artery bypass grafting were randomly allocated into three groups. Patients in group 1 (n=15) was recevied trimetazidine (20 mg x 3 per day) 7 days before surgery. Patients in group 2 (n=15) received GIK infusion after induction of anesthesia through the first 12 hours of intensive care unit convalescence. Patients in group 3 (n=15) were control group. Measurements of blood glucose, circulating creatine kinase MB (CK-MB) and Troponin I (TnI) concentra­tions were obtained before surgery, 5 minutes after completion of operation and at 12, 24, and 48 hours postoperatively. Mean pulmonary artery pressure, cardiac index, morbidity and data associated with operation were recorded in all patients preop­eratively and postoperatively. Results: Preoperative risk profiles and operative variables were statistically similar when the groups were compared. The concentration of circulating CK-MB and Tn I significantly in­creased over time after off - pump coronary artery surgery, with no significant intergroup differences. Cardiac index and mean pulmonary artery pressure did not differ significantly between groups. Conclusion: Pretreatment with trimetazidine and GIK infusion protocol were used as an adjunct to ischemic - reperfusion therapy in off - pump coronary artery bypass surgery. These results suggested that pretreatment with trimetazidine and GIK infusion protocol do not significantly reduce ischemic reperfu­sion damage.

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