Association between Ranolazine, Ischemic Preconditioning, and Cardioprotection in Patients Undergoing Scheduled Percutaneous Coronary Intervention

• Published in: Medicina (Kaunas, Lithuania) Lithuania), 2024-01, Vol.60 (1), p.166
• Main Authors: Kourtis, Konstantinos, Bourazana, Angeliki, Xanthopoulos, Andrew, Skoularigkis, Spyridon, Papadakis, Emmanouil, Patsilinakos, Sotirios, Skoularigis, John
• Format: Article
• Language: English
• Subjects: Angina pectoris; Angioplasty; Cardiac patients; cardioprotection; coronary; Coronary artery bypass; Creatine kinase; Enzymes; Humans; intervention; Intubation; Ischemia; Ischemic Preconditioning; Kinases; Medical research; Medicine, Experimental; Oxidation; percutaneous; Percutaneous Coronary Intervention; preconditioning; Prospective Studies; Ranolazine; Ranolazine - pharmacology; Ranolazine - therapeutic use; Regression analysis; Transluminal angioplasty; Troponin I; Variance analysis
• ISSN: 1648-9144; 1010-660X; 1648-9144
• DOI: 10.3390/medicina60010166

: Remote ischemic preconditioning (RIPC) has demonstrated efficacy in protecting against myocardial ischemia-reperfusion injury when applied before percutaneous coronary revascularization. Ranolazine, an anti-ischemic drug, has been utilized to minimize ischemic events in chronic angina patients. However, there is a lack of trials exploring the combined effects of ranolazine pretreatment and RIPC in patients undergoing percutaneous coronary interventions (PCIs). The present study is a prospective study which enrolled 150 patients scheduled for nonemergent percutaneous coronary revascularization. Three groups were formed: a control group undergoing only PCIs, an RIPC group with RIPC applied to either upper limb before the PCI (preconditioning group), and a group with RIPC before the PCI along with prior ranolazine treatment for stable angina (ranolazine group). Statistical analyses, including ANOVAs and Kruskal-Wallis tests, were conducted, with the Bonferroni correction for type I errors. A repeated-measures ANOVA assessed the changes in serum enzyme levels (SGOT, LDH, CRP, CPK, CK-MB, troponin I) over the follow-up. Statistical significance was set at < 0.05. : The ranolazine group showed (A) significantly lower troponin I level increases compared to the control group for up to 24 h, (B) significantly lower CPK levels after 4, 10, and 24 h compared to the preconditioning group ( = 0.020, = 0.020, and = 0.019, respectively) and significantly lower CPK levels compared to the control group after 10 h ( = 0.050), and (C) significantly lower CK-MB levels after 10 h compared to the control group ( = 0.050). : This study suggests that combining RIPC before scheduled coronary procedures with ranolazine pretreatment may be linked to reduced ischemia induction, as evidenced by lower myocardial enzyme levels.