Sodium arginine succinate in elective PCI: a randomized trial of ischemia-reperfusion syndrome prevention

Objective. To evaluate the effect of perioperative arginine sodium succinate infusion therapy on the incidence of ischemia-reperfusion syndrome (SIR) in patients with stable coronary artery disease (CHD) during elective percutaneous coronary intervention (PCI). Materials and methods. A single-center prospective, randomized, partially blind, open-label intervention study was conducted. The study included patients aged 60 years and older, regardless of gender, with a Charlson comorbidity index of at least 4 points. A total of 113 patients were screened, of which 9 were excluded according to the non-inclusion criteria and 16 according to the exclusion criteria. The final sample included 88 patients divided into two groups: the arginine sodium succinate group (n=43); the Ringer’s solution group (n=45). Infusion therapy in both groups was performed once at a dose of 10 ml/kg/day. The infusion started 30 minutes before PCI. The primary endpoint of the study is the incidence of SIR within 30 days after PCI. SIR was diagnosed based on a composite criterion, including: electrocardiography (ECG) data; echocardiography (EchoCG) results; laboratory markers of myocardial damage; thrombotic markers. It should be noted that limiting the sample to patients aged 60 years and older with a Charlson index >4 increases the risk of complications, which makes it possible to more clearly identify the potential preventive effect of cytoprotective therapy. At the same time, this approach severely limits the generalizability of the results obtained: the conclusions of the study cannot be directly extrapolated to younger age groups or patients with a lower comorbid load. Results. Perioperative use of arginine sodium succinate was associated with an almost twofold decrease in the incidence of SIR compared with Ringer’s solution, especially in patients with a SYNTAX Score of 8—15 points (p=0.040). Conclusion. The use of arginine sodium succinate was accompanied by a decrease in the incidence of SIR in patients who underwent elective PCI, which indicates the prospects of its use in the perioperative period. The results obtained should be considered as preliminary and requiring confirmation in large multicenter studies.