title: Effects of endothelin A receptor blockade in patients with ST-elevation acute coronary syndrome--a rhythmologic substudy.
abstract: OBJECTIVE
  Ventricular arrhythmias are common after acute myocardial infarction (AMI). Endothelin (ET) is a mediator of microvascular dysfunction and cardiac remodeling with arrhythmogenic potential. The aim of this study was to assess safety and feasibility of selective ET-A receptor blockade in ST-elevation acute coronary syndrome (STE-ACS) within a larger randomized trial.
  
  
  METHODS
  Patients with posterior-wall STE-ACS were randomly assigned to receive intravenous BQ-123 at 400 nmol/min or placebo over 60 min, starting immediately prior to primary percutaneous coronary intervention. Twenty-four hour Holter recordings were performed during hospitalization for STE-ACS and after 6-8 weeks. The predefined primary endpoint was the documentation of ventricular tachycardia and/or late potentials at follow-up.
  
  
  RESULTS
  There was no significant difference in the predefined primary endpoint at 45 (33-62) days (0/16 (0%) in BQ-123 treated patients vs. 1/14 (7%) in the placebo group, p=0.465). At 2 (1-3) days, an increase in the total number of supraventricular extrasystoles (SVES)/24 h in patients randomized to BQ-123 (45 (17-165) beats vs. 11 (5-72) beats in placebo treated patients, p=0.025) occurred. This increase was also observed at 45 days (105 (37-216) beats vs. 11 (3-98) beats in placebo treated patients, p=0.037). There was no significant difference regarding other rhythmologic secondary endpoints between the two groups.
  
  
  CONCLUSIONS
  Based on the analysis of long-term ECG data, short-term administration of BQ-123 after AMI was safe. Because of the small sample size, no firm conclusion regarding antiarrhythmic efficacy can be drawn.
authors.affiliation: Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Austria.
authors.forename: Christopher
authors.initials: C
authors.lastname: Adlbrecht
authors.affiliation: Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Austria.
authors.forename: Raphael
authors.initials: R
authors.lastname: Wurm
authors.affiliation: Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pezawas
authors.affiliation: Department of Cardiac Surgery, Informatics and Intelligent Systems, Vienna, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Andreas
authors.affiliation: Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Austria.
authors.forename: Bassam
authors.initials: B
authors.lastname: Redwan
authors.affiliation: Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Austria.
authors.forename: Klaus
authors.initials: K
authors.lastname: Distelmaier
authors.affiliation: Center for Medical Statistics, Informatics and Intelligent Systems, Vienna, Austria.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Kaider
authors.affiliation: Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Austria. Electronic address: irene.lang@meduniwien.ac.at.
authors.forename: Irene M
authors.initials: IM
authors.lastname: Lang
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D065128:Endothelin Receptor Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D044022:Receptor, Endothelin A / Q000378:metabolism*; D014463:Ultrasonography
chemical_list: D065128:Endothelin Receptor Antagonists; D044022:Receptor, Endothelin A
keywords: Acute myocardial infarction; Arrhythmia; BQ-123; Endothelin; Percutaneous coronary intervention; Reperfusion