lornoxicam and Myocardial-Infarction

10% of patients with acute ST-elevation myocardial infarction (STEMI) treated with reperfusion therapy fail to develop an enzyme rise, but do exhibit transient ECG changes, which are consistent with an aborted myocardial infarction. Following reperfusion by primary PCI in STEMI, oxidative stress and an inflammatory response are induced immediately. Inflammation is a critical component of STEMI. Both COX isoforms are involved in reperfusion and ischemic myocardial injury. To evaluate the effectiveness of lornoxicam - nonselective NSAID, in decrease of myocardial injury during acute ST-elevation myocardial infarction. We analyzed 22 patients with STEMI, 14 of them received 16 mg and 8 mg lornoxicam after 20 min and 8 hours, respectively, after arrival to hospital. 12 f them received alteplase, 10 patients with cardiac pain up to 24 hours from the beginning, did not receive reperfusion therapy. All patients received anticoagulants, antiplatlet therapy, -blockers. The primary end point was all-cause mortality by the day 30 and hospitalization due to congestive heart failure by the 1st year. There was no difference in mortality and heart failure by the 30 day and 1st year respectively, between the patients with STEMI treated with lornoxicam or placebo. Randomized controlled trials are needed to explore potential cardioprotective effects of lornoxicam in patients with acute STEMI.

Topics: Administration, Sublingual; Aged; Anti-Inflammatory Agents, Non-Steroidal; Cardiotonic Agents; Drug Evaluation; Electrocardiography; Female; Fibrinolytic Agents; Follow-Up Studies; Heart Failure; Hospital Mortality; Humans; Male; Middle Aged; Monitoring, Physiologic; Myocardial Infarction; Myocardial Reperfusion; Myocardial Reperfusion Injury; Piroxicam; Thrombolytic Therapy; Time Factors; Tissue Plasminogen Activator; Treatment Outcome

Activation of inflammation and enzyme cyclooxygenase with formation of proinflammatory prostaglandins is a key element of development of myocardial infarction in patients with acute coronary syndrome. Basing on literature data and own experience we suggested that single intravenous injection of 230 mg/kg of nonselective inhibitor of type 1 and 2 cyclooxygenase lornaxicam in the phase of initialization of inflammation 20 min after onset of ischemia would lead to reduction of myocardial infarction volume in rats in irreversible ischemia and ischemia with subsequent reperfusion. The conducted study allowed to reveal that administration of lornoxicam in recommended for human use dose lowered mortality of animals and increased number of capillaries per one cardiomyocyte in case of irreversible coronary artery occlusion. In ischemia-reperfusion as in irreversible myocardial ischemia lornoxicam reduced volume of necrosis and degree of thinning of left ventricular wall in the region of infarction, and lowered volume of connective tissue in periinfarction zone of the myocardium in remote period.

Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Disease Models, Animal; Dose-Response Relationship, Drug; Heart Ventricles; Male; Myocardial Infarction; Piroxicam; Rats; Reperfusion Injury; Treatment Outcome