الفهرس 
AMIOnly 14 pages are availabe for public view
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Abstract
Acute STEMI is the most serious presentation of CAD carrying the most hazardous consequences and it is caused by occlusion of major coronary artery with primary goal in the management to start reperfusion therapy as early as possible.
Restoration of the coronary flow facilitates cardiomyocyte salvage and decreases cardiac morbidity and mortality. However, reperfusion may result in paradoxical cardiomyocyte dysfunction, a phenomenon termed reperfusion injury.
Trimetazidine is a metabolic anti-ischemic drug which is beneficial in reducing peri-procedural myocardial reperfusion injury.
The aim of the work is to study the effect of trimetazidine on myocardial salvage index in patients with acute STEMI who underwent primary PCI.
This study was conducted on forty patients presented to Ain Shams university hospital by acute STEMI eligible for reperfusion therapy within the period between September 2010 and July 2011.
All patients underwent primary PCI after diagnostic coronary angiography, the IRA was identified and treated using bare metal stents ± pre-dilatation by balloons according to discretion of treating physician.
Before primary PCI all patients were given an intravenous dose of Tc-99m labeled sestamibi (20-30 mCi) then, after primary intervention 1st SPECT image was taken within 6 hours from the time of injection of the radioactive material to assess the initial size of the perfusion defect prior to reperfusion (myocardium at risk).
Prior to discharge the patients received another dose of Tc-99m labeled sestamibi (20-30 mCi) and follow up SPECT image was taken to assess the final perfusion defect and to calculate myocardial salvage and myocardial salvage index.
Patients were classified into 2 groups, group 1 included twenty patients who received 70 mg trimetazidine loading before primary PCI and continued on 70 mg /day in 2 divided doses till the second SPECT image (study group) and group 2 included twenty patients who did not receive trimetazidine (control group).
There was no statistically significant difference between both groups in spite of nearly equal initial perfusion defect and smaller final perfusion defect and better myocardial salvage index in group 1.
Myocardial salvage index was higher in patients with post procedural TIMI 3 flow than in patients with post procedural TIMI 2 flow in both groups with statistically significant higher myocardial salvage index in patients who received trimetazidine before primary PCI and non statistically significant difference in patients who did not receive trimetazidine.
There was nearly equal myocardial salvage index in both groups in patients with post procedural TIMI 2 flow but it was slightly higher in patients who received trimetazidine before primary PCI.
Among patients with post procedural TIMI 3 flow in spite of larger initial perfusion defect, the final size of infarction was smaller and myocardial salvage index was higher in group 1 who received trimetazidine than group 2, yet it was not statistically significant.