Coronary Artery Bypass Surgery Clinical Trial
Official title:
Mechanisms of Nitrite Mediated Cardioprotection in Coronary Artery Bypass Surgery
The purpose of this study is to determine whether sodium nitrite administration 24 hours prior to or during coronary artery bypass surgery protects the heart better from lack of blood flow which occurs as part of this type of operation. The study will also determine what the mechanisms of this cardioprotection are.
In recent years, there has been much interest in sodium nitrite as a cytoprotective agent in
in vitro and animal models. A recent study undertaken in a canine model of myocardial
infarction demonstrated a 50% reduction in myocardial injury following the administration of
sodium nitrite prior to the ischemic event. In humans, the setting of coronary artery bypass
surgery lends itself well to study potential cytoprotective agents. During cardiac surgery,
the heart undergoes a period of ischemia allowing the surgeons to operate on the heart. This
is followed by a period of reperfusion which in itself can add to cellular injury. Such
injury can hinder post-operative myocardial recovery.
The aim of this pilot study is to determine whether the cardioprotective effects of sodium
nitrite demonstrated in animal models are translated in humans and to determine the exact
underlying mechanisms of this cytoprotection. Patients undergoing coronary artery bypass
grafting surgery who give written, informed consent will receive sodium nitrite 24 hours
prior to surgery, during cardiac surgery or placebo. Myocardial injury will be assessed
through the measurement of biochemical markers such as troponin T. Cardiac biopsy samples
will be obtained to determine underlying molecular mechanisms of this cardioprotection. The
other aim of this pilot study is to determine what dose of sodium nitrite (i.e.
0.2mcg/kg/min or 1mcg/kg/min) is optimal for cardioprotection. This study will form pilot
data also for a larger clinical trial with clinical endpoints.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Outcomes Assessor), Primary Purpose: Treatment
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