Given the multifactorial nature of IRI, pentoxifylline could be a promising agent for prevention of microvascular damage and reperfusion injury by different mechanisms. Pentoxifylline is a methylxanthine derivative used to be prescribed for patients with intermittent claudication in previous decades (Salhiyyah et al. It has been documented that in a significant number of patients, microvascular damage can occur despite proper recanalization of culprit artery (Rezkalla and Kloner 2002). Despite numerous advances in the treatment of patients with acute coronary syndrome (ACS), the mortality and morbidity in this population are still high and clinical investigations into the prevention and treatment of IRI in order to improve outcomes in this setting are still ongoing. However, the process of reperfusion can damage the myocardium and leads to further ischemia in a paradoxical manner called myocardial ischemia reperfusion injury (IRI) (Yellon and Hausenloy 2007). In this regard, reestablishing efficient perfusion to salvage myocardium either pharmacologically or via percutaneous coronary intervention (PCI) is of top priority in patients with myocardial ischemia. cTFC corrected TIMI frame count, ED emergency department, IRI ischemia reperfusion injury, MBG myocardial blush grade, PCI percutaneous coronary intervention, PPCI primary PCI, PTX pentoxifylline, ROS reactive oxygen species, SD standard deviation, STEMI ST-elevation myocardial infarction, TIMI thrombolysis in myocardial infarction.Īcute myocardial infarction (MI) caused by coronary occlusion can initiate time-dependent myocardiocyte death and may lead to irreversible myocardial scaring if not treated promptly (Sandoval and Jaffe 2019). Panel B: study design and main results of the PENTOS-PCI trial. Panel A, background: pentoxifylline is a methylxanthine derivative with known anti-inflammatory, antioxidant, vasodilator, and rheological properties which can be a promising agent in preventing reperfusion injury. Intravenous administration of pentoxifylline was well tolerated, and there were no significant differences regarding adverse drug reactions in the two groups. Administration of intravenous pentoxifylline before primary PCI did not improve the success rate of the procedure in patients with STEMI. The rates of major adverse cardiac and treatment emergent adverse effects were not significantly different between the two groups. In addition, pentoxifylline could not improve secondary angiographic endpoints including myocardial blush grade 3 (87.5% and 85.2%, P = 0.79) and corrected TIMI frame count (22.8 and 24.0, P = 0.33) in the intervention and placebo groups respectively. Per-protocol analysis of primary endpoint indexing PCI’s success rate as measured by thrombolysis in myocardial infarction (TIMI) flow grade 3 was not significantly different between pentoxifylline and placebo (71.3% and 66.3% respectively, P = 0.40).
Overall, 161 patients were included in our study of whom 80 patients were assigned to pentoxifylline and 81 to the control groups.
Patients with acute STEMI who were eligible for PCI were randomized to receive either 100-mg intravenous infusion of pentoxifylline or placebo, prior to transferring to catheterization laboratory.
#Timi 3 flow. trial
PENTOS-PCI is a single-center, randomized, double-blind, placebo-controlled trial which evaluated the efficacy and safety of preprocedural administration of intravenous pentoxifylline in patients undergoing primary percutaneous coronary intervention (PCI). Pentoxifylline is a methylxanthine derivative with known anti-inflammatory, antioxidant, vasodilator, and rheological properties which can be a promising agent in preventing reperfusion injury. Ischemia reperfusion injury can lead to further myocardiocyte damage in patients with ST-elevation myocardial infarction (STEMI).
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