The Efficacy of Parecoxib on Systemic Inflammatory Response Associated with Cardiopulmonary Bypass During Cardiac Surgery

AIMS:

Cardiopulmonary bypass (CPB) during cardiac surgery is well known to be associated with the development of a systemic inflammatory response. The efficacy of parecoxib in attenuating this systemic inflammatory response is still unknown.

METHODS:

Patients undergoing elective mitral valve replacement with CPB were assessed, enrolled and randomly allocated to receive parecoxib (80mg) or placebo. Blood samples were collected in EDTA vials for measuring Serum Cytokine levels, Troponin T, CK-MB levels and white cell counts.

RESULTS:

Compared with control group, IL-6 and IL-8 values in parecoxib group increased to a lesser extent, peaking at 2hours after the end of CPB (IL-6: 31.8±4.7 vs. 77.0±14.1, 95%CI -47.6, -42.8, P<0.001; IL-8: 53.6±12.6 vs. 105.7±10.8, 95%CI -54.8, -49.4, P<0.001). Peak levels of anti-inflammatory cytokine IL-10 occurred immediately after termination of CPB and was higher in the parecoxib group (115.7±10.5 vs. 88.4±12.3, 95%CI 24.7, 29.9, P<0.001). Furthermore, the increase in neutrophil counts caused by CPB during cardiac surgery was inhibited by parecoxib. The increases in Serum Troponin T and CK-MB levels were also significantly attenuated by parecoxib in the early postoperative day. Peak serum levels of CK-MB in both groups occurred at 24h post CPB (17.4±5.2 vs. 26.9±6.9, 95%CI -10.9, -8.1, P<0.001). Peak troponin T levels occurred at 6 hours post bypass (2±0.62 VS. 3.5±0.78, 95%CI -1.7, -1.3, P<0.001).

CONCLUSION:

Intraoperative parecoxib attenuated systemic inflammatory response associated with CPB during cardiac surgery and lowered the biochemical markers of myocardial injury.