Impact of intravenous exenatide infusion for perioperative blood glucose control on myocardial ischemia-reperfusion injuries after coronary artery bypass graft surgery: sub study of the phase II/III ExSTRESS randomized trial
Abstract Background The aim of the study was to investigate whether intravenous (iv) infusion of exenatide, a synthetic GLP-1 receptor agonist, could provide a protective effect against myocardial ischemia-reperfusion injury after coronary artery bypass graft (CABG) surgery. Methods A sub study anal...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-11-01
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| Series: | Cardiovascular Diabetology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12933-018-0784-y |
| _version_ | 1818029845273116672 |
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| author | Guillaume Besch Andrea Perrotti Lucie Salomon du Mont Marc Puyraveau Xavier Ben-Said Maude Baltres Benoit Barrucand Guillaume Flicoteaux Lucie Vettoretti Emmanuel Samain Sidney Chocron Sebastien Pili-Floury |
| author_facet | Guillaume Besch Andrea Perrotti Lucie Salomon du Mont Marc Puyraveau Xavier Ben-Said Maude Baltres Benoit Barrucand Guillaume Flicoteaux Lucie Vettoretti Emmanuel Samain Sidney Chocron Sebastien Pili-Floury |
| author_sort | Guillaume Besch |
| collection | DOAJ |
| description | Abstract Background The aim of the study was to investigate whether intravenous (iv) infusion of exenatide, a synthetic GLP-1 receptor agonist, could provide a protective effect against myocardial ischemia-reperfusion injury after coronary artery bypass graft (CABG) surgery. Methods A sub study analysis of patients > 18 years admitted for elective CABG and included in the ExSTRESS trial was conducted. Patients were randomized to receive either iv exenatide (1-h bolus of 0.05 µg min−1 followed by a constant infusion of 0.025 µg min−1) (exenatide group) or iv insulin therapy (control group) for blood glucose control (target range 100–139 mg dl−1) during the first 48 h after surgical incision. All serum levels of troponin I measured during routine care in the Cardiac Surgery ICU were recorded. The primary outcome was the highest value of plasma concentration of troponin I measured between 12 and 24 h after ICU admission. The proportion of patients presenting an echocardiographic left ventricular ejection fraction (LVEF) > 50% at the follow-up consultation was compared between the two groups. Results Finally, 43 and 49 patients were analyzed in the control and exenatide groups, respectively {age: 69 [61–76] versus 71 [63–75] years; baseline LVEF < 50%: 6 (14%) versus 16 (32%) patients; on-pump surgery: 29 (67%) versus 33 (67%) patients}. The primary outcome did not significantly differ between the two groups (3.34 [1.06–6.19] µg l−1 versus 2.64 [1.29–3.85] µg l−1 in the control and exenatide groups, respectively; mean difference (MD) [95% confidence interval (95% CI)] 0.16 [− 0.25; 0.57], p = 0.54). The highest troponin value measured during the first 72 h in the ICU was 6.34 [1.36–10.90] versus 5.04 [2.39–7.18] µg l−1, in the control and exenatide groups respectively (MD [95% CI] 0.20 [− 0.22; 0.61], p = 0.39). At the follow-up consultation, 5 (12%) versus 8 (16%) patients presented a LVEF < 50% in the control and in the exenatide groups respectively (relative risk [95% CI] 0.68 [0.16; 2.59], p = 0.56). Conclusions Postoperative iv exenatide did not provide any additional cardioprotective effect compared to iv insulin in low-risk patients undergoing scheduled CABG surgery. Trial registration ClinicalTrials.gov Identifier NCT01969149, date of registration: January 7th, 2015; EudraCT No. 2009-009254-25 A, date of registration: January 6th, 2009 |
| first_indexed | 2024-12-10T05:26:09Z |
| format | Article |
| id | doaj.art-ed50e840df5d4da785426c431fe5629c |
| institution | Directory Open Access Journal |
| issn | 1475-2840 |
| language | English |
| last_indexed | 2024-12-10T05:26:09Z |
| publishDate | 2018-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Diabetology |
| spelling | doaj.art-ed50e840df5d4da785426c431fe5629c2022-12-22T02:00:41ZengBMCCardiovascular Diabetology1475-28402018-11-0117111110.1186/s12933-018-0784-yImpact of intravenous exenatide infusion for perioperative blood glucose control on myocardial ischemia-reperfusion injuries after coronary artery bypass graft surgery: sub study of the phase II/III ExSTRESS randomized trialGuillaume Besch0Andrea Perrotti1Lucie Salomon du Mont2Marc Puyraveau3Xavier Ben-Said4Maude Baltres5Benoit Barrucand6Guillaume Flicoteaux7Lucie Vettoretti8Emmanuel Samain9Sidney Chocron10Sebastien Pili-Floury11Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, and, EA3920 and SFR-FED 4234 INSERM, University of Franche-ComteDepartment of Cardiothoracic Surgery, University of Franche-ComteDepartment of Vascular Surgery, University Hospital of Besancon, and, EA3920, University of Franche-ComteClinical Methodology Center, University Hospital of Besancon, University of Franche-ComteDepartment of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, and, EA3920 and SFR-FED 4234 INSERM, University of Franche-ComteDepartment of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, and, EA3920 and SFR-FED 4234 INSERM, University of Franche-ComteDepartment of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, and, EA3920 and SFR-FED 4234 INSERM, University of Franche-ComteDepartment of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, and, EA3920 and SFR-FED 4234 INSERM, University of Franche-ComteDepartment of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, and, EA3920 and SFR-FED 4234 INSERM, University of Franche-ComteDepartment of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, and, EA3920 and SFR-FED 4234 INSERM, University of Franche-ComteDepartment of Cardiothoracic Surgery, University Hospital of Besancon, and, EA3920, University of Franche-ComteDepartment of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, and, EA3920 and SFR-FED 4234 INSERM, University of Franche-ComteAbstract Background The aim of the study was to investigate whether intravenous (iv) infusion of exenatide, a synthetic GLP-1 receptor agonist, could provide a protective effect against myocardial ischemia-reperfusion injury after coronary artery bypass graft (CABG) surgery. Methods A sub study analysis of patients > 18 years admitted for elective CABG and included in the ExSTRESS trial was conducted. Patients were randomized to receive either iv exenatide (1-h bolus of 0.05 µg min−1 followed by a constant infusion of 0.025 µg min−1) (exenatide group) or iv insulin therapy (control group) for blood glucose control (target range 100–139 mg dl−1) during the first 48 h after surgical incision. All serum levels of troponin I measured during routine care in the Cardiac Surgery ICU were recorded. The primary outcome was the highest value of plasma concentration of troponin I measured between 12 and 24 h after ICU admission. The proportion of patients presenting an echocardiographic left ventricular ejection fraction (LVEF) > 50% at the follow-up consultation was compared between the two groups. Results Finally, 43 and 49 patients were analyzed in the control and exenatide groups, respectively {age: 69 [61–76] versus 71 [63–75] years; baseline LVEF < 50%: 6 (14%) versus 16 (32%) patients; on-pump surgery: 29 (67%) versus 33 (67%) patients}. The primary outcome did not significantly differ between the two groups (3.34 [1.06–6.19] µg l−1 versus 2.64 [1.29–3.85] µg l−1 in the control and exenatide groups, respectively; mean difference (MD) [95% confidence interval (95% CI)] 0.16 [− 0.25; 0.57], p = 0.54). The highest troponin value measured during the first 72 h in the ICU was 6.34 [1.36–10.90] versus 5.04 [2.39–7.18] µg l−1, in the control and exenatide groups respectively (MD [95% CI] 0.20 [− 0.22; 0.61], p = 0.39). At the follow-up consultation, 5 (12%) versus 8 (16%) patients presented a LVEF < 50% in the control and in the exenatide groups respectively (relative risk [95% CI] 0.68 [0.16; 2.59], p = 0.56). Conclusions Postoperative iv exenatide did not provide any additional cardioprotective effect compared to iv insulin in low-risk patients undergoing scheduled CABG surgery. Trial registration ClinicalTrials.gov Identifier NCT01969149, date of registration: January 7th, 2015; EudraCT No. 2009-009254-25 A, date of registration: January 6th, 2009http://link.springer.com/article/10.1186/s12933-018-0784-yCoronary artery bypassExenatideIncretinsGlucagon-like peptide 1Myocardial reperfusion injuryCardioprotective effects |
| spellingShingle | Guillaume Besch Andrea Perrotti Lucie Salomon du Mont Marc Puyraveau Xavier Ben-Said Maude Baltres Benoit Barrucand Guillaume Flicoteaux Lucie Vettoretti Emmanuel Samain Sidney Chocron Sebastien Pili-Floury Impact of intravenous exenatide infusion for perioperative blood glucose control on myocardial ischemia-reperfusion injuries after coronary artery bypass graft surgery: sub study of the phase II/III ExSTRESS randomized trial Cardiovascular Diabetology Coronary artery bypass Exenatide Incretins Glucagon-like peptide 1 Myocardial reperfusion injury Cardioprotective effects |
| title | Impact of intravenous exenatide infusion for perioperative blood glucose control on myocardial ischemia-reperfusion injuries after coronary artery bypass graft surgery: sub study of the phase II/III ExSTRESS randomized trial |
| title_full | Impact of intravenous exenatide infusion for perioperative blood glucose control on myocardial ischemia-reperfusion injuries after coronary artery bypass graft surgery: sub study of the phase II/III ExSTRESS randomized trial |
| title_fullStr | Impact of intravenous exenatide infusion for perioperative blood glucose control on myocardial ischemia-reperfusion injuries after coronary artery bypass graft surgery: sub study of the phase II/III ExSTRESS randomized trial |
| title_full_unstemmed | Impact of intravenous exenatide infusion for perioperative blood glucose control on myocardial ischemia-reperfusion injuries after coronary artery bypass graft surgery: sub study of the phase II/III ExSTRESS randomized trial |
| title_short | Impact of intravenous exenatide infusion for perioperative blood glucose control on myocardial ischemia-reperfusion injuries after coronary artery bypass graft surgery: sub study of the phase II/III ExSTRESS randomized trial |
| title_sort | impact of intravenous exenatide infusion for perioperative blood glucose control on myocardial ischemia reperfusion injuries after coronary artery bypass graft surgery sub study of the phase ii iii exstress randomized trial |
| topic | Coronary artery bypass Exenatide Incretins Glucagon-like peptide 1 Myocardial reperfusion injury Cardioprotective effects |
| url | http://link.springer.com/article/10.1186/s12933-018-0784-y |
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