Distal myocardial protection during percutaneous coronary intervention with an intracoronary beta-blocker.
BACKGROUND
Experimental studies have demonstrated that intravenous beta-blocker administration before coronary artery occlusion significantly reduces myocardial injury. Clinical studies have shown that intracoronary (IC) propranolol administration before percutaneous coronary intervention (PCI) delays myocardial ischemia. The present study tested the hypothesis that IC propranolol treatment protects ischemic myocardium from myocardial damage and reduces the incidence of myocardial infarction (MI) and short-term adverse outcomes after PCI.


RESULTS
Patients undergoing PCI (n=150) were randomly assigned in a double-blind fashion to receive IC propranolol (n=75) or placebo (n=75). Study drug was delivered before first balloon inflation via an intracoronary catheter with the tip distal to the coronary lesion. Biochemical markers were evaluated through the first 24 hours and clinical outcomes to 30 days. Evidence of MI with creatine kinase-MB elevation after PCI was seen in 36% of placebo and 17% of propranolol patients (P=0.01). Troponin T elevation was seen in 33% of placebo and 13% of propranolol patients (P=0.005). At 30 days, the composite end point of death, postprocedural MI, non-Q-wave MI after PCI hospitalization, or urgent target-lesion revascularization occurred in 40% of placebo versus 18% of propranolol patients (hazard ratio 2.14, 95% CI 1.24 to 3.71, P=0.004).


CONCLUSIONS
IC administration of propranolol protects the myocardium during PCI, significantly reducing the incidence of MI and improving short-term clinical outcomes.
Wang
Fen Wei
FW
Department of Internal Medicine, Division of Cardiology, The University of Texas Medical Branch at Galveston, 301 University Blvd, 5.106 JSHA, Galveston, Tex 77555-0553, USA.
Osman
Abdulfatah
A
Otero
Javier
J
Stouffer
George A
GA
Waxman
Sergio
S
Afzal
Adnan
A
Anzuini
Angelo
A
Uretsky
Barry F
BF
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D001241:Aspirin / Q000008:administration & dosage; D015415:Biomarkers / Q000032:analysis; D003324:Coronary Artery Disease / Q000628:therapy*; D003402:Creatine Kinase / Q000032:analysis; D052279:Creatine Kinase, MB Form; D004311:Double-Blind Method; D005260:Female; D006321:Heart / Q000187:drug effects; D006801:Humans; D007269:Injections, Intra-Arterial; D007527:Isoenzymes / Q000032:analysis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011433:Propranolol / Q000008:administration & dosage*; D012306:Risk; D018401:Sample Size; D016019:Survival Analysis; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D015415:Biomarkers; D007527:Isoenzymes; D010975:Platelet Aggregation Inhibitors; D011433:Propranolol; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form; D001241:Aspirin