Safety of combination therapy with milrinone and esmolol for heart protection during percutaneous coronary intervention in acute myocardial infarction.
OBJECTIVE
Ischemia/reperfusion injury remains an untreated clinical problem in patients with acute myocardial infarction (AMI) despite significant advances in emergent revascularization through percutaneous coronary intervention (PCI). Pharmacological intervention for infarct size reduction is unavailable. We have identified that the medications milrinone and esmolol, when administered together at the beginning of the reperfusion, significantly decrease infarct size via reducing reperfusion injury in an experimental model. The present study tested the safety of combination therapy of milrinone and esmolol (M + E) in patients with AMI.


METHODS
Sixteen subjects with AMI requiring PCI were consecutively recruited. M + E was intravenously infused simultaneously for 10 min started at 5 min before anticipated angioplasty balloon inflation. Another 16 consecutively recruited AMI patients requiring PCI served as a placebo arm treated per routine clinical protocol. Blood pressure (BP) and heart rate (HR) were monitored continuously during PCI.


RESULTS
M + E combination therapy resulted in a trend of non-significant reduction in BP compared with a control group. There was a modest but significant increase in HR at the later phase of M + E infusion compared with a control group. No significant cardiac arrhythmia was induced during M + E infusion.


CONCLUSIONS
The combination therapy with M + E produces a minimal change in hemodynamics and appears safe as an adjunctive therapy to PCI in AMI patients. Further studies are warranted.
Cardiac Department, National University Heart Center, National University Health System, 1E Kent Ridge Rd, NUHS Tower Block, Level 9, Singapore, 19228, Singapore, kian_keong_poh@nuhs.edu.sg.
Kian-Keong
KK
Poh
Xin
X
Xu
Mark Y
MY
Chan
Chi-Hang
CH
Lee
Edgar L
EL
Tay
Adrian F
AF
Low
Koo Hui
KH
Chan
Winnie
W
Sia
Liang-Qiu
LQ
Tang
Huay Cheem
HC
Tan
Charles Y
CY
Lui
Vincent
V
Nguyen
Kenichi
K
Fujise
Ming-He
MH
Huang
D001794:Blood Pressure / Q000187:drug effects; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D020105:Milrinone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000601:surgery; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D062645:Percutaneous Coronary Intervention; D011412:Propanolamines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D011412:Propanolamines; D020105:Milrinone; C036604:esmolol