The Effect of High-Dose Vitamin C on Biochemical Markers of Myocardial Injury in Coronary Artery Bypass Surgery

Abstract

ObjectiveTo evaluate the effect of high-dose vitamin C on cardiac reperfusion injury and plasma levels of creatine kinase-muscle/brain (CK-MB), troponin I, and lactate dehydrogenase (LDH) in patients undergoing coronary artery bypass grafting (CABG).MethodsThis is a double-blind randomized clinical trial study. Fifty patients (50-80 years old) who had CABG surgery were selected. The intervention group received 5 g of intravenous vitamin C before anesthesia induction and 5 g of vitamin C in cardioplegic solution. The control group received the same amount of placebo (normal saline). Arterial blood samples were taken to determine the serum levels of CK-MB, troponin I, and LDH enzymes. Left ventricular ejection fraction was measured and hemodynamic parameters were recorded at intervals.ResultsHigh doses of vitamin C in the treatment group led to improvement of ventricular function (ejection fraction [EF]) and low Intensive Care Unit (ICU) stay. The cardiac enzymes level in the vitamin C group was lower than in the control group. These changes were not significant between the groups in different time intervals (anesthesia induction, end of bypass, 6 h after surgery, and 24 h after surgery) for CK-MB, LDH, and troponin I. Hemodynamic parameters, hematocrit, potassium, urinary output, blood transfusion, arrhythmia, and inotropic support showed no significant difference between the groups.ConclusionVitamin C has significantly improved the patients’ ventricular function (EF) 72 h after surgery and reduced the length of ICU stay. No significant changes in cardiac biomarkers, including CK-MB, troponin I, and LDH, were seen over time in each group.IRCT codeIRCT2016053019470N33

Vitamin C for Cardiac Protection during Percutaneous Coronary Intervention: A Systematic Review of Randomized Controlled Trials

“…The overall findings here are consistent with the data on the cardioprotective effect of VC from clinical trials of coronary reperfusion surgery patients. Two of these clinical trials showed that administration of VC before coronary artery bypass grafting (CABG) surgery significantly improved LVEF [ 56 , 57 ]. Similar to the PCI trials presented here, VC was given via iv infusion before CABG and was found to reduce cardiac injury [ 56 , 57 ].…”

“…Two of these clinical trials showed that administration of VC before coronary artery bypass grafting (CABG) surgery significantly improved LVEF [ 56 , 57 ]. Similar to the PCI trials presented here, VC was given via iv infusion before CABG and was found to reduce cardiac injury [ 56 , 57 ]. Three systematic reviews with meta-analysis have summarized the benefit of VC for CABG and cardiac surgery patients [ 45 , 46 , 47 , 48 ] .…”

Vitamin C supplementation in cardiopulmonary bypass: a review

“…Patients had lower oxidative damage, lower myocardial damage, better postoperative cardiac index and shorter hospital stay. Emadi et al (22) observed improved ventricular function 72 h after surgery and reduced length of intensive care unit stay. Two other studies showed increased levels of plasma malondialdehyde (MDA), a marker of lipid peroxidation, after CPB (10,30).…”

Combating Ischemia-Reperfusion Injury with Micronutrients and Natural Compounds during Solid Organ Transplantation: Data of Clinical Trials and Lessons of Preclinical Findings

“…In one clinical study, vitamin C treatment could increase the beneficial effects of ß-blocker against AF in patients undergoing CABG [ 276 ]. However, some clinical studies were not able to find significant effects on heart enzymes [ 267 , 277 ], inflammation markers [ 278 ] or AF [ 266 ]. In animal models, beneficial effects of vitamin C supplemented preservation solution in terms of graft protection have been observed [ 279 ].…”

“…Transplantation [260] -Varying concentrations AA [260] blood circulation improved hyperfibrinolysis by improvement of clot rigidity [260] Vitamin C Heart CABG [265,266,[274][275][276][277][278] percutaneous coronary intervention [269,270] cardiac surgery [267,273] PAD [271] valve replacement surgery [274,278] pump circulation during surgery [265] i.v. [266,267,270,271,273,274,277] p.o.…”