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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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ORIGINAL ARTICLES CARDIAC SECTION
The Journal of Cardiovascular Surgery 2015 August;56(4):617-29
Effect of preoperative oral pravastatin reload in systemic inflammatory response and myocardial damage after coronary artery bypass grafting. A pilot double-blind placebo-controlled study
Castaño M. 1, González-Santos J. M. 2, López J. 2, García B. 3, Centeno J. E. 2, Aparicio B. 4, Bueno M. J. 2, Díez R. 2, Sagredo V. 5, Rodríguez J. M. 6, García-Criado F. J. 3 ✉
1 Department of Cardiac Surgery, León University Hospital, León, Spain;
2 Department of Cardiac Surgery, Salamanca University Hospital, Salamanca, Spain;
3 Department of Surgery, School of Medicine, University of Salamanca, Salamanca Spain;
4 Departments of Biochemistry, Salamanca University Hospital, Salamanca Spain;
5 Department of Intensive Care Medicine, Salamanca University Hospital, Salamanca Spain;
6 Department and Anesthesiology, Salamanca University Hospital, Salamanca Spain
AIM: Statins exert pleiotropic effects that result in cardioprotective and antiinflammatory properties. There is a lack of information about the effect of preoperative reloading statin administration in surgical coronary patients regarding myocardial protection, systemic inflammatory response (SIR) attenuation and nitric oxide (NO) metabolism.
METHODS: Thirty consecutive dyslipidemic patients under chronic treatment with statins were randomized to orally receive pravastatin 80 mg (N.=10), 40 mg (N.=10) or placebo (N.=10) two hours before anesthetic induction for non-emergent on-pump coronary artery bypass grafting (CABG) procedures. Perioperative peripheral venous and intraoperative CS blood samples were collected for determination of drug-related adverse effects, NO metabolism and both myocardial damage and SIR biomarkers.
RESULTS: Pravastatin reloading resulted in a significant and dose-related intense attenuation of SIR, but no differences in cardiac damage biomarker levels were demonstrated. NO release and inducible nitric oxide synthase expression was significantly reduced in both treatment groups. Highest pravastatin doses significantly increased systemic creatine phosphokinase (CPK) concentration compared with intermediate doses but no other adverse effects were observed.
CONCLUSION: Oral pravastatin reloading before non-emergent CABG significantly attenuates postoperative SIR and systemic NO/iNOS concentrations with no effect in perioperative myocardial damage. Highest pravastatin doses increase CPK levels and must be avoided in susceptible patients.