The impact of Allopurinol use on one-year outcome of patients with acute anterior myocardial infarction undergoing PPCI

Abstract

Reperfusion by primary angioplasty is still the most effective treatment for ST-segment elevation (STEMI). On the other hand, allopurinol prevents tissue damage caused by ischemia and reperfusion and also improves left ventricular function in many animal models. Therefore, in this study, considering the possible efficacy of this drug in patients with acute anterior infarction who have undergone primary angioplasty and the cheapness and availability of this drug, the effects of allopurinol administration in primary angioplasty on the clinical outcome on a significant number of STEMI patients and in a one-year follow-up period was investigated. Methods and Materials: In this clinical trial - (Clinical Trial) 170 patients with the first anterior STEMI who referred to Shahid Madani Hospital in Tabriz less than 12 hours after the onset of symptoms and underwent successful primary angioplasty were included in the study. After applying the inclusion criteria, patients were randomly divided into two groups of 85 patients receiving allopurinol (intervention group) and receiving the standard protocol (control group). The intervention group received 300 mg of allopurinol before angioplasty and then 100 mg daily for one month before the start of angioplasty. The two groups were then evaluated for in-hospital MACE and followed up for one year for clinical outcomes. Clinical outcomes studied included mortality, stroke, and heart failure. Telephone calls were made to patients in 1-6-12 months. Results: The mean age of the control group was 57.15 ±13.39 years and in the intervention group was 55.23 ± 11.05 years, but no significant difference was observed between the two groups (P value = 0.066). The mean time of DBT (Door to Balloon time) in the control group was 50.06 ± 16.3 minutes and in the intervention group was 60.76 ± 19.38 minutes and there was a significant difference between the two groups (P value = 0.001). In other words, patients in the intervention group had a longer time than the control group. The incidence of major cardiac complication (MACE) before discharge was recorded for 7 patients (8.2%) in the control group and 12 patients (14.1%) in the intervention group, but there was no significant difference between the two groups (Relative risk=0.714 =, 95% Confidence interval =0.70 – 4.14, P value= 0.224). A total of 16 patients (18.8%) from the control group and 23 patients (27.1%) from the intervention group had complications during the one-year follow-up period (CVA, death, cardiovascular complication before discharge, HF during the follow-up period). There was no significant difference between the two groups (P value = 0.202).