Article of the Month – August 2016

By the Cardiopulmonary Bypass Committee

Title: Cardiac protection with phosphocreatine: a meta-analysis.

URL: http://icvts.oxfordjournals.org/content/early/2016/06/17/icvts.ivw171.full.pdf+html

DOI:10.1093/icvts/ivw171

Published: 17th June 2016

Authors: Landoni G, Zangrillo A, Lomivorotov VV, Likhvantsev V, Ma J, De Simone F, Fominskiy E.

Study description and main objective:

This meta-analysis, including 41 studies with 5069 patients, investigates whether administration of Phosphocreatine in patients with coronary artery disease, chronic heart failure or in those undergoing cardiac surgery has an effect on all-cause short-term (in-hospital) mortality?

This research question is based on the assumption that Phosphocreatine is an intracellular key player supporting myocardial contractility.

 Main findings:

This meta-analysis is the largest and the first to suggest that treatment with Phosphocreatine in patients with acute and chronic cardiac pathologies, including patients undergoing cardiac surgery, has the potential to reduce in-hospital all-cause mortality.

In addition other cardiovascular relevant outcome variables, including left ventricular ejection fraction, myocardial ischaemic serum markers, major arrhythmias and inotrope use were improved in patients treated with Phosphocreatine.

Clinical impact and questions:

  1. How much extracellular (intravascular) Phosphocreatine actually arrives intracellularly in order to have a positive effect on myocardial contractility?
  2. What is current practice in cardiac anaesthesia, do cardiac centres use Phosphocreatine peri-operatively in order to potentially protect the myocardium and improve postoperative outcomes?
  3. Based on the results of this meta-analyses, treating patients with acute and chronic heart pathology with Phosphocreatine has the potential to reduce in-hospital mortality – should we now administer Phosphocreatine as a treatment option for ischaemia reperfusion injury peri-operatively in cardiac surgical patients?
  4. When is the best time to add Phosphocreatine peri-operatively, as a bolus (1-2g) before and after cardiopulmonary bypass or administered into the cardioplegia (8-10mmol/l)?
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