The Effect of Intravenous Vitamin C Infusion on Periprocedural Myocardial Injury for Patients Undergoing Elective Percutaneous Coronary Intervention

• Published in: Canadian journal of cardiology Vol. 30; no. 1; pp. 96 - 101
• Main Authors: Wang, Zhi Jian, MD, Hu, Wen Kun, MD, Liu, Yu Yang, MD, Shi, Dong Mei, MD, Cheng, Wan Jun, MD, Guo, Yong He, MD, Yang, Qing, MD, Zhao, Ying Xin, MD, Zhou, Yu Jie, MD, PhD
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 2014
• Subjects: Antioxidants - administration & dosage; Ascorbic Acid - administration & dosage; Biomarkers - blood; Cardiovascular; Coronary Angiography; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - metabolism; Coronary Artery Disease - surgery; Creatine Kinase, MB Form - blood; Elective Surgical Procedures - methods; Electrocardiography; Female; Follow-Up Studies; Humans; Infusions, Intravenous; Male; Middle Aged; Myocardial Reperfusion Injury - diagnostic imaging; Myocardial Reperfusion Injury - metabolism; Myocardial Reperfusion Injury - prevention & control; Oxidative Stress - drug effects; Percutaneous Coronary Intervention - methods; Preoperative Care - methods; Prospective Studies; Treatment Outcome; Troponin - blood
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2013.08.018

Abstract Background This small study has determined the effect of vitamin C on myocardial reperfusion in patients undergoing elective percutaneous coronary intervention (PCI). This study was to explore whether antioxidant vitamin C infusion before the procedure is able to affect the incidence of periprocedural myocardial injury (PMI) in patients undergoing PCI. Methods In this prospective single-centre randomized study, 532 patients were randomized into 2 groups: the vitamin C group, which received a 3-g vitamin C infusion within 6 hours before PCI, and a control group, which received normal saline. The primary end point was the troponin I–defined PMI, and the second end point was the creatine kinase (CK)-MB–defined PMI. Separate analyses using both end points were performed. PMI was defined as an elevation of cardiac biomarker values (CK-MB or troponin I) > 5 times the upper limit of normal (ULN), alone or associated with chest pain or ST-segment or T-wave changes. Results After PCI, the incidence of PMI was reduced, whether defined by troponin or by CK-MB, compared with the control group (troponin I, 10.9% vs 18.4%; P  = 0.016; CK-MB, 4.2% vs 8.6%; P  = 0.035). Logistic multivariate analysis showed that preprocedure use of vitamin C is an independent predictor of PMI either defined by troponin I (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.33-0.97; P  = 0.037) or by CK-MB (OR, 0.37; 95% CI, 0.14-0.99; P  = 0.048). Conclusions In patients undergoing elective PCI, preprocedure intravenous treatment with vitamin C is associated with less myocardial injury.