Improving myocardial perfusion by percutaneous coronary intervention reduces central sympathetic activity in stable angina.
BACKGROUND
By stimulating sympathetic afferents, repetitive myocardial ischemia induces a state of increased sympathetic tone.


OBJECTIVE
Removing the ischemic trigger by revascularization using percutaneous coronary intervention (PCI) might thus reduce central sympathetic activity in symptomatically stable angina patients.


METHODS
A total of 20 patients with stable angina > or = New York Heart Association (NYHA) class II with persistent symptoms despite maximal pharmacological therapy and a clinical indication for PCI, were included in our study. Sympathetic nervous system activity was measured before and 1 month after PCI by a combination of techniques: direct muscle sympathetic nerve activity (MSNA), neurochemical (plasma catecholamine levels), and heart rate variability (HRV).


RESULTS
All patients completed the study. After PCI there was a significant reduction in MSNA (pre-PCI 72 +/- 4 to post-PCI 53 +/- 4 burst/100 beats, P < .05) and low frequency/high frequency (LF/HF) ratio (3.7 +/- 0.6 vs 2.4 +/- 0.4, P < .05) consistent with a decline in sympathetic activity. Plasma norepinephrine levels were reduced after PCI, but this difference did not reach statistical significance (1.84 +/- 0.17 vs 1.73 +/- 0.13 nmol/L, P = not significant).


CONCLUSIONS
Coronary revascularization by PCI reduces sympathetic activity in patients with established myocardial ischemia.
Gomes
Marc E
ME
Department of Cardiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Aengevaeren
Wim R
WR
Lenders
Jacques W
JW
Verheugt
Freek W
FW
Smits
Paul
P
Tack
Cees J
CJ
D000368:Aged; D000787:Angina Pectoris / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D003326:Coronary Circulation; D004558:Electric Stimulation; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000294:innervation; D017202:Myocardial Ischemia / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D009426:Netherlands; D009638:Norepinephrine / Q000097:blood; D012720:Severity of Illness Index; D013564:Sympathetic Nervous System / Q000378:metabolism / Q000503:physiopathology*; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D009638:Norepinephrine