title: Distal myocardial protection with intracoronary beta blocker when added to a Gp IIb/IIIa platelet receptor blocker during percutaneous coronary intervention improves clinical outcome.
abstract: OBJECTIVE
  The present study tested the hypothesis that intracoronary (IC) propranolol improves clinical outcomes with percutaneous coronary intervention (PCI) when used with background Gp IIb/IIIa receptor blockade.
  
  
  BACKGROUND
  We have previously shown that administration of a relatively large weight-based IC dose of the beta blocker propranolol before PCI decreases the incidence of post-PCI myocardial infarction (MI) and improves short- and long-term outcome. It has previously been shown that administration of a Gp IIb/IIIa receptor blocker decreases post-PCI MI and improves short- and long-term clinical outcome.
  
  
  METHODS
  Patients undergoing PCI (n = 400) were randomized in a prospective double-blind fashion to IC propranolol (n = 200) or placebo (n = 200) with eptifibatide administered to all the patients. Myocardial isoform of creatine kinase was measured during the first 24 hr and clinical outcomes at 30 days and 1 year.
  
  
  RESULTS
  MI after PCI was seen in 21.5% of placebo and 12.5% of propranolol patients (relative risk reduction 0.42; 95%CI 0.09, 0.63; P = 0.016). At 30 days, the composite end point of death, post-procedural MI, urgent target lesion revascularization, or MI after index hospitalization occurred in 22.5% of placebo vs. 13.5% of propranolol patients (risk reduction 0.43; 95%CI 0.08, 0.65; P = 0.018). Similar results were observed at 1 year with adverse outcomes in 21.5% of propranolol and 32.5% of placebo patients (P = 0.01).
  
  
  CONCLUSIONS
  IC propranolol administration with the background Gp IIb/IIIa receptor blockade significantly reduces the incidence of post-PCI MI and improves the short- and long-term clinical outcome when compared with a Gp IIb/IIIa blocker alone.
authors.affiliation: Division of Cardiology, University of Texas Medical Branch at Galveston, Texas, USA. buretsky@sparks.org
authors.forename: Barry F
authors.initials: BF
authors.lastname: Uretsky
authors.forename: Yochai
authors.initials: Y
authors.lastname: Birnbaum
authors.forename: Abdulfatah
authors.initials: A
authors.lastname: Osman
authors.forename: Rajiv
authors.initials: R
authors.lastname: Gupta
authors.forename: Oscar
authors.initials: O
authors.lastname: Paniagua
authors.forename: Antonio
authors.initials: A
authors.lastname: Chamoun
authors.forename: Amir
authors.initials: A
authors.lastname: Pohwani
authors.forename: Charles
authors.initials: C
authors.lastname: Lui
authors.forename: Eli
authors.initials: E
authors.lastname: Lev
authors.forename: Todd
authors.initials: T
authors.lastname: McGehee
authors.forename: Darren
authors.initials: D
authors.lastname: Kumar
authors.forename: Asif
authors.initials: A
authors.lastname: Akhtar
authors.forename: Angelo
authors.initials: A
authors.lastname: Anzuini
authors.forename: Ernst R
authors.initials: ER
authors.lastname: Schwarz
authors.forename: Fen Wei
authors.initials: FW
authors.lastname: Wang
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D052279:Creatine Kinase, MB Form / Q000097:blood; D004311:Double-Blind Method; D004333:Drug Administration Routes; D004359:Drug Therapy, Combination; D000077542:Eptifibatide; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000201:enzymology / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D010455:Peptides / Q000008:administration & dosage*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D011433:Propranolol / Q000008:administration & dosage*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D015415:Biomarkers; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011433:Propranolol; D052279:Creatine Kinase, MB Form; D000077542:Eptifibatide