The Effect Of Ranolazine Treatment Administered Before Coronary Artery Bypass Surgery On Perioperative Myocardial Damage In Patients With Stable Angina Pectoris

INTRODUCTION: Ranolazine is a piperazine derivative that has been approved as an antianginal agent. It is primarily used as a second- line antianginal agent in stable coronary artery disease. The study was designed considering that the active ingredient ranalozine, which has antiischemic effects through ischemic sodium channels, can reduce ischemia in the perioperative period and reduce the frequency of perioperative myocardial infarction.
METHODS: The study included patients with stable angina pectoris who underwent coronary angiography between January 1, 2015 and June 30, 2016 at Koþuyolu Training and Research Hospital and who were diagnosed with multi-vessel disease or LMCA disease, and then for whom the joint council of Cardiology-Cardiovascular Surgery made a decision in favor of coronary artery bypass grafting.
RESULTS: The mean age was 61.2 ± 8.6 years in the ranolazine group, while the mean age of the patients receiving standard therapy was 57.9 ± 8.8 years (p = 0.073).The EuroSCOREs of the patients before the operation which were used to predict intraoperative mortality were similar. Mean troponin value of Group 1 patients at 0 hour was 1.70 (1.13-2.77), while mean troponin value of the patients in Group 2 at 0 hour was 2.76(1.69-6.20) (p=0,01).
DISCUSSION AND CONCLUSION: In the present study, the immediate postoperative troponin 0 value was found to be lower in the ranolazine group. There was no statistical difference in terms of troponin values measured at 12 and 24 hours. In this study, we showed that early myocardial damage was significantly reduced with ranolazine treatment.

Stabil Angina Pektorisli Hastalarda Koroner Arter Baypas Cerrahisi Öncesi Ranolazin Tedavisinin Peroperatif Miyokard Hasarý Üzerine Etkisi

GÝRÝÞ ve AMAÇ: Stabil anjina pektoris(SAP), mortalite ve yaþam kalitesi üzerinde önemli etkisi olan kronik bir hastalýktýr. Ranolazin, bir antianjinal olarak onaylanan bir piperazin türevidir. Öncelikle stabil koroner arter hastalýðýnda ikinci basamak antianjinal olarak kullanýlýr. Ranolazin geç sodyum kanallarýný (INa) bloke ederek etki eder ve sitosolik kalsiyumun yükselmesini önler. Çalýþmamýz ranalozinin, perioperatif dönemde iskemiyi azaltabileceði ve miyokard hasarýný azaltabileceði düþünülerek tasarlanmýþtýr.
YÖNTEM ve GEREÇLER: Çalýþmaya 1ocak 2015 ile 30 haziran 2016 tarihleri arasýnda Kartal Koþuyolu Yüksek Ýhtisas Eðitim Araþtýrma Hastanesi Kardiyoloji Anabilim Dalýnda koroner anjiyografi (KAG) uygulanmýþ ve çok damar hastalýðý veya LMCA hastalýðý tespit edilip, daha sonra Kardiyoloji- Kalp Damar Cerrahisi ortak konseyinde CABG kararý verilen stabil angina pektorisli hastalar alýndý. CABG dýþýnda baþka bir cerrahi prosedür (mitral kapak onarýmý, mitral kapak deðiþimi aort kapak deðiþimi gibi) uygulanan hastalar çalýþmadan dýþlandý. Araþtýrma protokolü için hastanemiz etik kurulundan gereken izin alýndý.
BULGULAR: Ranolazin alan grupta ortalama yaþ 61,2±8,6 iken standart tedavi alan hastalarýn ortalama yaþý 57,9±8,8 olarak saptandý. (p=0,073). Hastalarýn operasyon öncesi deðerlendirilen ve iþlem sýrasýndaki mortaliteyi öngörmek amacýyla kullanýlan EuroSCORE’ larý benzerdi. 1.Grup hastalarýn ortalama 0. Saat troponin deðeri 1.70 (1.13-2.77) iken 2. Grup hastalarýn 0. Saat troponin deðeri 2.76(1.69-6.20) (p=0,01).
TARTIÞMA ve SONUÇ: Çalýþmamýzda postoperatif olarak hemen bakýlan troponin 0 deðeri ranolazin alan grupta daha düþük saptandý. 12. Ve 24. Saatte bakýlan troponin deðerleri bakýmýndan istatistiksel fark saptanmadý. Çalýþmamýzda erken dönem miyokard hasarýnýn ranolozýn tedavisi ile anlamlý olarak azaldýðýný gösterdik.