The impact of alpha lipoic acid administration on oxidative stress markers and occurrence of no-reflow phenomenon in post myocardial infarction patients

Background

Primary percutaneous coronary intervention (PPCI) is the treatment of choice for ST-segment-elevation myocardial infarction (STEMI). Post-PCI induced-oxidative stress, a complication of PCI, is linked to the no-reflow (NR) phenomenon and poor prognosis. A clinical trial involving 70 STEMI patients was conducted to evaluate the impact of alpha lipoic acid (ALA), an antioxidant and anti-inflammatory agent, on oxidative stress and NR. The participants were randomized to standard care (control group) or 600 mg IV infusion of ALA pre/peri PPCI then 600 mg orally once for 28 days plus standard care (ALA group). Outcomes included the degree of myocardial reperfusion by thrombolysis in myocardial infarction (TIMI) flow and myocardial blush grade (MBG), Aldehyde dehydrogenase 2 (ALDH2) and Paroxonase 1 (PON-1) levels, also left ventricular ejection fraction (LVEF), and major adverse cardiac events (MACE).

Results

TIMI flow grade-3 and MBG grade-3 were significantly higher in the ALA group versus controls (97.1% and 62.9%, respectively, P = 0.001, 82.9%, and 45.7%, respectively, P = 0.002). ALDH2 and PON-1 levels were significantly higher in ALA versus controls post-PPCI at all-time points (24 h and 7 days). The ALA group exhibited better LVEF at 7 and 28 days when compared to controls.

Conclusion

ALA supplementation decreased the occurrence of NR, reduced myocardial ischemia–reperfusion injury (IRI) post-PPCI, increased ALDH2, and PON-1 levels, and improved LVEF.