Cardiovascular Disease, Ischemic Heart Disease
Conditions
Keywords
ischemia reperfusion injury, CABG, dipyridamole, HS-troponin-I
Brief summary
Rationale: Due to western lifestyle human coronary arteries are prone to develop atherosclerotic plaques. Hence the heart is an important target organ for atherothrombotic complications: myocardial ischemia, arrhythmias, myocardial infarction and heart failure. To alleviate symptoms and decrease mortality in these patients, myocardial revascularisation is recommended. Coronary artery bypass grafting (CABG) is indicated in patients with severe atherosclerotic disease of all three coronary arteries or the left main stem coronary artery. Cardiac ischemia and reperfusion injury during CABG is inevitable and jointly accountable for complications that occur after CABG (e.g. death, myocardial infarction, arrhythmias, stroke, or renal complications). Dipyridamole has been shown to reduce ischemia reperfusion injury in healthy volunteers using an intermediate endpoint and may prevent cardiovascular death or event in secondary prevention after cerebrovascular disease. The investigators hypothesise that oral pre-treatment with dipyridamole can increase cardiac tissue tolerance against ischemia and reperfusion injury due to CABG. The investigators expect lower troponin-I release in patients who were pretreated with dipyridamole. Objective: To study the effect of oral pretreatment with dipyridamole on high sensitivity (HS)-troponin-I release after CABG. Secondary objectives are whether oral pretreatment with dipyridamole reduces postoperative CABG arrhythmias, prolonged inotropic support, and duration of Intensive Care-stay. Further secondary endpoints are the effects of dipyridamole pretreatment on renal injury and post-ischemic recovery of contractile function (measured ex-vivo). Hypothesis: The investigators hypothesize that oral pre-treatment with dipyridamole can increase cardiac tissue tolerance against ischemia and reperfusion injury. The investigators expect lower HS-troponin-I release in patients who were pretreated with dipyridamole. Additionally the investigators expect the incidence of arrhythmias, need for prolonged inotropic support (longer than 24 hours postoperative) to be decreased in pretreated patients.
Interventions
DRUGDipyridamole
prior to CABG surgery 3 day treatment with dipyridamole 200mg SR twice daily
DRUGplacebo
prior to CABG surgery 3 day treatment with placebo capsules twice daily
Sponsors
Radboud University Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Acceptation for CABG in RUNMC * Informed consent
Exclusion criteria
* Recent myocardial infarction (STEMI or non-STEMI), during two weeks prior to inclusion * Asthma * Use of insulin * Use of sulfonylurea derivates (e.g. glibenclamide, tolbutamide, gliclazide, glimepiride) * Use of metformin * Use of oral corticosteroids * Use of dipyridamole * Use of clopidogrel within 8 days prior to scheduled CABG surgery * Chronic use of Non Steroid Anti-Inflammatory Drugs (NSAIDs) * Off-pump surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| HS-troponin-I | within 72 hours after CABG. | high sensitivity cardiac troponin-I |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| duration of inotropic support | within three days after CABG | — |
| duration of IC stay | within three days after CABG | — |
| drain production | 24 hours after surgery and total drain production within three days after surgery | thoracic drain production after CABG |
| post-ischemic recovery of contractile function | until 4 hours after harvesting | The right atrial appendage is harvested during cardiac surgery before the introduction of the extracorporal circulation. Two atrial trabeculae are dissected, suspended in an organ bath, and linked to a force transducer. after equilibration and baseline measurement, simulated ischemia and reperfusion influences contractile force recovery |
| Renal damage | Within three days after CABG | biomarkers for renal failure will be detemined in blood and urine before and after CABG |
Countries
Netherlands
Outcome results
None listed