Does allopurinol improve inflammatory biomarkers and post-revascularization coronary blood flow in Non-STEMI patients?

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Isfahan University of Medical Sciences, isfahan, Iran. Background Medical evidence suggests inflammatory processes responsible for the incidence of cardiovascular events including acute coronary syndrome and increased oxidative stress have a substantial role in cardiac events pathogenesis and prognosis. In the recent studies, usage of allopurinol has shown promising outcomes in favor of reducing oxidative processes responsible for atherogenic-related cardiovascular events and ischemia-reperfusion injury. Purpose This study aims to assess the effects of allopurinol bolus on the inflammatory biomarkers and post-revascularization coronary blood flow according to Thrombolysis in Myocardial Infarction (TIMI) flow grading in patients with non-ST segment elevated myocardial infarction (NSTEMI). Methods In this randomized double blind clinical trial, Eighty NSTEMI patients were randomly divided into two groups, including the case group (n=40) medicated with a high loading dose of 600 mg allopurinol before the coronary angiography and angioplasty, while the control group (n=40) received the same shape medication as a placebo. The highly sensitive C-reactive protein (hs-CRP) was measured at baseline and within 24 hours after the cardiac interventions and compared between the case and control groups. Post percutaneous coronary intervention (PCI) TIMI flow grading was also evaluated as a revascularization outcome and coronary blood flow. The patients were also monitored for incidence of ischemic symptoms and occurrence of major adverse cardiac events (MACEs) as well as ventricular and supra-ventricular arrhythmia. Results The mean age of study population was 60.03 (10.02) and 62.78 (11.37) in case and control groups respectively (P-value=0.22). The two groups of the study were similar in terms of demographic, clinical, laboratory and angiographic characteristics (P-value>0.05). TIMI flow grading assessments as the revascularization endpoint revealed insignificant difference between cases versus controls in both prior to (P-value=0.14) and after (P-value=0.39) the PCI. Post-angiographic assessment of adjusted hs-CRP revealed an insignificant statistically difference between the cases and the controls (P-value=0.104). The incidence of ischemic symptoms, arrhythmia and MACEs were similar between the groups (P-value>0.05). Conclusion Our findings showed that, premedication with high dose allopurinol bolus in NSTEMI patients did not affect on hs-CRP, as an inflammatory biomarker, as well as revascularization outcome (according to TIMI flow). Further long-term studies on more extended biomarkers are strongly recommended.