Intravenous Ascorbic Acid Infusion Improves Myocardial Perfusion Grade During Elective Percutaneous Coronary Intervention

Abstract

In patients undergoing elective percutaneous coronary intervention, impaired microcirculatory reperfusion is improved by vitamin C infusion suggesting that oxidative stress is implicated in such a phenomenon.

Patients with microvascular obstruction after primary percutaneous coronary intervention show a gp91phox (NOX2) mediated persistent oxidative stress after reperfusion

“…11 The same group also showed that the rate of TIMI myocardial perfusion grade <2, a measure of microvascular perfusion after PCI, was higher in placebo-treated patients (32%) as compared to vitamin C-treated patients (4%). 39 Finally, accordingly to previous data, 1 we found that patients with a long ischemic time had a higher incidence of MVO. A trend to a higher rate of MVO occurrence was observed in our study in diabetic patients and in patients with a raised inflammatory milieu, as assessed by C-reactive protein levels.…”

Aspirin Reload Before Elective Percutaneous Coronary Intervention

“…7 Depending on the population under study and the diagnostic techniques used for its detection, the incidence of no-reflow ranges from 5% to 50%, and it is considered a hallmark of poor cardiovascular outcome. 7,[21][22][23][24][25][26] Several mechanisms seem to be involved in no-reflow phenomenon including thrombus embolization from epicardial artery and peripheral vasospasm as a consequence of reduced formation of vasodilating molecules such as nitric oxide or upregulation of vasoconstrictive molecules. 15 A previous study demonstrated that in patients on chronic 100 mg aspirin treatment, serum thromboxane B 2 is increased immediately after elective PCI.…”

Anoxia-Reoxygenation Enhances Platelet Thromboxane A 2 Production via Reactive Oxygen Species–Generated NOX2

“…3 Briefly, 56 patients (47 men and 9 women, mean age 67 [50 to 84] years) were enrolled in the study. Informed consent was obtained from each participating subject, and the ethics committee of the Sapienza University of Rome approved the study protocol.…”

“…1,2 Accordingly, percutaneous coronary intervention (PCI), a typical in vivo model of ischemia-reperfusion, has been associated with overproduction of isoprostanes, which are markers of oxidative stress, as well as with impaired microcirculatory flow. 3 Furthermore, in vitro experiments of anoxia-reoxygenation (AR) demonstrated enhanced platelet activation via formation of thromboxane (Tx) A 2 ; this may negatively influence the circulatory flow by predisposing to thrombotic complication. 4 AR-induced platelet TxB 2 formation follows arachidonic acid release by platelet membrane via ROS-induced phospholipase A 2 (PLA 2 ) activation.…”