HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Matthias Thielmann Ulf Herold Markus Kamler Parwis Massoudy Heinz Jakob Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Thielmann, M. Articles by Jakob, H. Search for Related Content PubMed PubMed Citation Articles by Thielmann, M. Articles by Jakob, H. Related Collections Cardiac - pharmacology Coronary disease Myocardial infarction Myocardial protection

Eur J Cardiothorac Surg 2006;30:285-293
© 2006 Elsevier Science NL

Administration of C1-esterase inhibitor during emergency coronary artery bypass surgery in acute ST-elevation myocardial infarction

^a Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital of Essen, Hufelandstraße 55, 45122 Essen, Germany
^b Institute for Medical Informatics, Biometry, and Epidemiology, University Hospital of Essen, Essen, Germany

Received 4 October 2005; received in revised form 8 April 2006; accepted 20 April 2006.

^_* Corresponding author. Tel.: +49 201 723 4928; fax: +49 201 723 5451. (Email: matthias.thielmann{at}uni-essen.de).

Objective: Myocardial inflammatory response including complement activation was demonstrated as an important mechanism of ischemia–reperfusion injury and complement inhibition by C1-esterase inhibitor (C1-INH) has recently shown to have cardioprotective effects in experimental and clinical settings. Methods: The effects of C1-INH on complement activation, myocardial cell injury, and clinical outcome were studied in patients undergoing emergency CABG due to acute ST-elevation myocardial infarction (STEMI) with (group 1, CABG + STEMI + C1-INH, n = 28) and without (group 2, CABG + STEMI, n = 29) bolus administration of C1-INH (40 IU kg^–1) during reperfusion and 6 h postoperatively (20 IU kg^–1) besides the same study protocol. C1-INH activity, C3c and C4 complement activation fragments, and cardiac troponin I (cTnI) were measured preoperatively and up to 48 h postoperatively and compared to another elective set of CABG patients without STEMI as controls (group 3, CABG–STEMI, n = 10). Clinical data, adverse events, and patient outcome were recorded prospectively. Results: Patient characteristics were not different between groups 1 and 2. No drug-related adverse events were observed. Constant plasma levels of C1-INH were found in group 1, but not in groups 2 and 3. Plasma levels of C3c and C4 complement fragments were reduced in all three groups after surgery throughout the observation time, but tended to be lower in groups 1 and 2 compared with group 3. Preoperative cTnI levels were elevated but not different between the groups 1 and 2. The area under curve (AUC), as well as the postoperative cTnI serum levels, was significantly lower (P < 0.05) in group 1 with a treatment delay 6 h between reperfusion and symptom onset compared to group 2 at 36 h (47.9 ± 11.1 ng/ml vs 97.7 ± 17.2 ng/ml; mean ± SEM), and 48 h (33.5 ± 5.8 ng/ml vs 86.5 ± 19.2 ng/ml) after surgery, but remained unchanged between groups among patients with a treatment delay of more than 6–24 h. In-hospital adverse events and postoperative complications, ICU and hospital stay, as well as in-hospital mortality (14.3% vs 13.8%; P = NS) were not different between groups 1 and 2. Conclusions: C1-INH administration in emergency CABG with acute STEMI is safe and effective to inhibit complement activation and may reduce myocardial ischemia–reperfusion injury as measured by cTnI.

Key Words: Coronary artery bypass grafting • ST-elevation myocardial infarction • Reperfusion injury • C1-esterase inhibitor

This article has been cited by other articles:

				E. Shagdarsuren, K. Bidzhekov, Y. Djalali-Talab, E. A. Liehn, M. Hristov, R. A. Matthijsen, W. A. Buurman, A. Zernecke, and C. Weber C1-Esterase Inhibitor Protects Against Neointima Formation After Arterial Injury in Atherosclerosis-Prone Mice Circulation, January 1, 2008; 117(1): 70 - 78. [Abstract] [Full Text] [PDF]

				G. Szeplaki, L. Varga, J. Laki, E. Dosa, S. Rugonfalvi-Kiss, H. O. Madsen, Z. Prohaszka, A. Kocsis, P. Gal, A. Szabo, et al. Low C1-Inhibitor Levels Predict Early Restenosis After Eversion Carotid Endarterectomy Arterioscler Thromb Vasc Biol, December 1, 2007; 27(12): 2756 - 2762. [Abstract] [Full Text] [PDF]

				K. Fattouch, G. Bianco, G. Speziale, R. Sampognaro, C. Lavalle, F. Guccione, P. Dioguardi, and G. Ruvolo Beneficial effects of C1 esterase inhibitor in ST-elevation myocardial infarction in patients who underwent surgical reperfusion: a randomised double-blind study Eur. J. Cardiothorac. Surg., August 1, 2007; 32(2): 326 - 332. [Abstract] [Full Text] [PDF]

				M. Thielmann, M. Neuhauser, A. Marr, U. Herold, M. Kamler, P. Massoudy, and H. Jakob Predictors and Outcomes of Coronary Artery Bypass Grafting in ST Elevation Myocardial Infarction Ann. Thorac. Surg., July 1, 2007; 84(1): 17 - 24. [Abstract] [Full Text] [PDF]