title: Beneficial effect of early infusion of landiolol, a very short-acting beta-1 adrenergic receptor blocker, on reperfusion status in acute myocardial infarction.
abstract: BACKGROUND
  An early IV beta blocker during primary percutaneous coronary intervention (PCI) has been shown to reduce infarct size in ST-segment elevation acute myocardial infarction (STEMI), although the underlying mechanism is unknown. The aim of this study was to investigate the efficacy of early infusion of landiolol, the short-acting beta-1 adrenergic receptor blocker, on the reperfusion status in a STEMI.
  
  
  METHODS
  We conducted a prospective, single-group trial of landiolol during the primary PCI for a STEMI. Landiolol was started intravenously just before reperfusion. The reperfusion status and outcomes in 55 treated patients were compared with those in 60 historical controls treated without landiolol. The optimal reperfusion was assessed by an ST-segment resolution (STR), coronary flow, and myocardial brush grade (MBG) after reperfusion.
  
  
  RESULTS
  Patients in the landiolol group achieved a higher rate of an STR (64% vs. 42%, p=0.023) and MBG 2/3 (64% vs. 45%, p=0.045), whereas coronary flow was comparable between the two groups. A multivariate analysis showed that landiolol use was an independent predictor of an STR (odds ratio 2.99, 95% confidence interval 1.25-7.16, p=0.014). The incidence of non-sustained ventricular tachycardia (27% vs. 50%, p=0.014), hypotension (15% vs. 32%, p=0.046), and progression to Killip class grade III or IV (0% vs. 10%, p=0.028) were lower in the landiolol group.
  
  
  CONCLUSIONS
  Early infusion of landiolol during the primary PCI was associated with optimal reperfusion and a lower incidence of adverse events in comparison with the control group.
authors.affiliation: Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Kiyokuni
authors.affiliation: Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany. Electronic address: m_koni@hotmail.com.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Konishi
authors.affiliation: Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Sakamaki
authors.affiliation: Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Chika
authors.initials: C
authors.lastname: Kawashima
authors.affiliation: Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Narikawa
authors.affiliation: Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Doi
authors.affiliation: Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Kiwamu
authors.initials: K
authors.lastname: Iwata
authors.affiliation: Division of Cardiology, Saiseikai Yokohama Southern Hospital, Yokohama, Japan.
authors.forename: Sakie
authors.initials: S
authors.lastname: Tomari
authors.affiliation: Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Nakayama
authors.affiliation: Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Komura
authors.affiliation: Division of Cardiology, Saiseikai Yokohama Southern Hospital, Yokohama, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Mitsuhashi
authors.affiliation: Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Hideto
authors.initials: H
authors.lastname: Yano
authors.affiliation: Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Teruyasu
authors.initials: T
authors.lastname: Sugano
authors.affiliation: Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Ishigami
authors.affiliation: Division of Cardiology, Saiseikai Yokohama Southern Hospital, Yokohama, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Endo
authors.affiliation: Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Ishikawa
authors.affiliation: Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Takeharu
authors.initials: T
authors.lastname: Yamanaka
authors.affiliation: Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kimura
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists / Q000008:administration & dosage*; D000368:Aged; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000008:administration & dosage*; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D015425:Myocardial Reperfusion / Q000379:methods*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome; D014508:Urea / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D009025:Morpholines; C077049:landiolol; D014508:Urea
keywords: Acute myocardial infarction; Adrenergic beta-antagonist; Percutaneous coronary intervention; Prognosis; Reperfusion injury