Abstract
Background In animal studies, hydrogen sulfide (H2S) has been shown to protect the heart from ischemia-reperfusion injury. This study evaluates the safety and tolerability of the H2S donor sodium thiosulfate (STS) in patients with acute coronary syndrome (ACS). Methods Eighteen patients, undergoing coronary angiography for ACS, received STS intravenously immediately after arrival at the catheterization laboratory according to a “3 + 3 dose-escalation design” with fixed dosing endpoint (0, 2.5, 5, 10, 12.5, and 15 grams). This first dose STS was combined with verapamil and nitroglycerin required for transradial procedures. A second dose STS was administered 6 hours later. Primary endpoint was dose-limiting toxicity, defined as significant hemodynamic instability or death up to 24 hours or before discharge from the coronary care unit. Secondary outcomes included the occurrence of anaphylaxis, nausea, vomiting, and systolic blood pressure (SBP) course. Results Sixteen patients received two dosages of STS and two patients one dosage. None of the patients reached the primary endpoint, nor experienced a serious adverse event. We observed a clinically well-tolerated decline in SBP 1 hour after administration of the first STS dose and concomitant verapamil/nitroglycerin. SBP for all patients together reduced 16.8 (8.1–25.5) mmHg (P = 0.0008). No significant decline in SBP occurred after the second dose. Mild nausea was observed in one patient. Conclusion This is the first report on sodium thiosulfate administration in patients with acute coronary syndromes. Our data suggest that sodium thiosulfate was well tolerated in this setting. The potential benefit of this intervention has to be examined in larger studies.
Highlights
And effective reperfusion by primary percutaneous coronary intervention (PPCI) is currently the most effective treatment of ST-segment elevation myocardial infarction (STEMI)
Exclusion criteria were the presence of a cardiomyopathy or impaired LV-ejection fraction
Fourteen patients were diagnosed with non-ST-segment elevation myocardial infarction (NSTEMI), two patients with unstable angina, and one patient had an aborted STEMI. 5 patients were classified with 0-vessel disease, and treatment was conservative: 4 patients presented with NSTEMI, due to transient thrombus (n = 1), microvascular disease (n = 1), spontaneous coronary artery dissection without any plaques or stenoses (n = 1), and the fourth patient had a history of STEMI without any new stenosis
Summary
And effective reperfusion by primary percutaneous coronary intervention (PPCI) is currently the most effective treatment of ST-segment elevation myocardial infarction (STEMI). Administration of hydrogen sulfide (H2S), an endogenous gaseous signaling molecule, has been shown to protect the heart from ischemia-reperfusion injury in various experimental models. It reduces infarct size and apoptosis and attenuates the loss of cardiac function. Iosulfate can be exogenously administered as sodium thiosulfate (STS), and next to its antioxidant properties, H2Srelated mitochondrial preservation and reduced apoptosis are experimentally proven cardioprotective mechanisms [18,19,20,21,22]. Is study evaluates the safety and tolerability of the H2S donor sodium thiosulfate (STS) in patients with acute coronary syndrome (ACS). We observed a clinically well-tolerated decline in SBP 1 hour after administration of the first STS dose and concomitant verapamil/ nitroglycerin. Our data suggest that sodium thiosulfate was well tolerated in this setting. e potential benefit of this intervention has to be examined in larger studies
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