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BMC Cardiovascular Disorders
Published in: BMC Cardiovascular Disorders 1/2023

Open Access 01-12-2023 | CABG | Research

Vitamin C may reduce troponin and CKMB levels after PCI and CABG: a meta-analysis

Authors: Sander Rozemeijer, Harri Hemilä, Marlinde van Baaren, Angélique M.E. de Man

Published in: BMC Cardiovascular Disorders | Issue 1/2023

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Abstract

Background

Ischemia/reperfusion injury contributes to periprocedural myocardial injury (PMI) in patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). PMI can be estimated by the elevation of troponin (Tn) and creatine kinase-MB (CKMB) plasma levels, and it is associated with increased risk of cardiovascular events and mortality. Vitamin C might have a beneficial effect on PMI by improving endothelial function, improving myocardial perfusion, and by reducing oxidative stress generated during/after reperfusion. In several small animal models of cardiac stress, vitamin C reduced the increase in Tn and CKMB levels. The aim of this meta-analysis was to investigate whether vitamin C administration may have an effect on Tn and CKMB levels in patients undergoing PCI or CABG.

Methods

We searched PubMed, Cochrane, Embase and Scopus databases for controlled clinical trials reporting on Tn and CKMB levels in adult patients who underwent PCI or CABG and received vitamin C. As secondary outcomes we collected data on biomarkers of oxidative stress in the included trials. In our meta-analysis, we used the relative scale and estimated the effect as the ratio of means.

Results

We found seven controlled trials which included 872 patients. All included trials administered vitamin C intravenously, with a range from 1 to 16 g/day, and all initiated vitamin administration prior to the procedure. Vitamin C decreased peak Tn plasma levels in four trials on average by 43% (95% CI: 13 to 63%, p = 0.01) and peak CKMB plasma levels in five trials by 14% (95% CI: 8 to 21%, p < 0.001). Vitamin C also significantly decreased the biomarkers of oxidative stress.

Conclusions

Vitamin C may decrease cardiac enzyme levels in patients undergoing elective PCI or CABG. This may be explained partially by its antioxidant effects. Our findings encourage further research on vitamin C administration during cardiac procedures and in other clinical contexts that increase the level of cardiac enzymes. Future studies should search for an optimal dosing regimen, taking baseline and follow-up plasma vitamin C levels into account.
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Metadata
Title
Vitamin C may reduce troponin and CKMB levels after PCI and CABG: a meta-analysis
Authors
Sander Rozemeijer
Harri Hemilä
Marlinde van Baaren
Angélique M.E. de Man
Publication date
01-12-2023
Publisher
BioMed Central
Keywords
CABG
CABG
Published in
BMC Cardiovascular Disorders / Issue 1/2023
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/s12872-023-03459-6

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