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Design of a trial evaluating myocardial cell protection with cariporide, an inhibitor of the transmembrane sodium-hydrogen exchanger: the Guard During Ischemia Against Necrosis (GUARDIAN) trial |
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| Authors: | Pierre Theroux Bernard R Chaitman Leif Erhardt Andreas Jessel Thomas Meinertz Wolf-Ulrich Nickel John S Schroeder Gianni Tognoni Harvey White James T Willerson |
| Institution: | 1. University of Montreal and Montreal Heart Institute, Montreal, Canada 2. St Louis University Medical Center, St Louis, Missouri, USA 3. Malmoe University Hospital, Malm?, Sweden 4. Hoechst Marion Roussel, Bridgewater, New Jersey, USA 5. Medizinische Universitaetsklinik Eppendorf, Hamburg, Germany 6. Stanford University Medical Center, Stanford, California, USA 7. Instituto M Negri, Milan, Italy 8. Green Lane Hospital, Auckland, New Zealand 9. University of Texas Medical School and Texas Heart Institute, Texas, USA |
| Abstract: | BackgroundDirect myocardial cell protection in patients with unstable angina or evolving myocardial infarction (MI) could prevent cell necrosis or reduce its extent, and minimize the risk of MI and death associated with percutaneous coronary interventions (PCIs) and coronary artery bypass surgery. The myocardial NHE plays a critical role in mediating the progression of ischemia to necrosis by promoting intracellular accumulation of sodium and calcium in exchange for hydrogen. Blockage of the system in various experimental models of ischemia and reperfusion had a strong antinecrotic effect. The present paper describes a trial that was intended to investigate the potential clinical benefit of cariporide, a potent and selective inhibitor of the NHE, in a large spectrum of at-risk patients. |
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