The Effect of Preoperative Oral Trimetazidine on Ischemic Injury and Hemodynamic Function in Coronary Artery Bypass Grafting: A Double-Blinded, Prospective, Randomized Controlled Trial

Abstract

Background: Ischemic and reperfusion injury can occur during coronary artery bypass grafting (CABG), leading to poor post-operative hemodynamic function. Pre-operative administration of oral Trimetazidine has been shown to reduce ischemic and reperfusion injury, however, the effects about hemodynamic function are still controversial. Material and Methods: Ninety patients that underwent CABG were randomly divided into two groups. The Trimetazidine group received oral Trimetazidine 35 mg twice a day for at least five days before the operation, and the control group received a placebo. Invasive cardiac output monitoring using a Swan Ganz catheter was performed in every case. The cardiac markers and hemodynamic parameters were evaluated before the operation, immediately after the operation, and then at 12 hours and 24 hours postoperatively. Results: There were no statistically significant differences in the rise of all cardiac markers from the preoperative values to the immediate postoperative values between the groups (p=0.471, 0.907 and 0.863 in Troponin T, CK-MB, and total CK, respectively). For postoperative cardiac marker levels, the level of CK-MB in the postoperative follow up period increased +1.51 mcg/L (95% CI -1.11, +4.12), in the Trimetazidine group and increased +0.93 mcg/L (95% CI; -1.78, +3.64) per follow up in the placebo group, but the rising rate between both groups had no statistically significant differences (p=0.670). Moreover, there were no statistically significant differences in the increased of the preoperative and postoperative cardiac index between the groups (p=0.102). Conclusion: The pre-operative administration of oral Trimetazidine did not significantly reduce ischemic and reperfusion injury during CABG, nor improve the postoperative hemodynamic function.