Myocardial protection during transient coronary artery occlusion in man: beneficial effects of regional beta-adrenergic blockade.

Zalewski, Andrew; Goldberg, Sheldon; Dervan, John P.; Slysh, Sonya; Maroko, Peter R.

doi:10.1161/01.cir.73.4.734

Cited by 89 publications

(22 citation statements)

References 26 publications

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“…[17][18][19][20] Human studies have demonstrated that IC propranolol before transient coronary artery occlusion can delay the onset and severity of myocardial ischemia as detected by surface electrocardiography without decreasing heart rate or blood pressure. 11,12 The present study demonstrates that IC ␤-blocker can also protect against myocardial injury in this setting. We propose that the effects of microembolization during PCI are often transient and that reperfusion of small myocardial areas occurs after dissolution of these microemboli.…”

Section: Discussionsupporting

confidence: 54%

“…Propranolol at a dose of 15 g/kg 12 or 0.9% NaCl (placebo) was injected into the coronary artery through the dilatation catheter, the distal tip of which was positioned across the stenosis or stenoses (if more than 1 site underwent PCI). The study drug was thus delivered directly into the myocardial region supplied by the stenotic coronary artery undergoing PCI.…”

Section: Study Protocolmentioning

confidence: 99%

“…[7][8][9][10] Clinical PCI studies have shown that intracoronary (IC) propranolol delays the development of ischemia during balloon occlusion as determined by the time to and extent of ST-segment elevation on IC and surface ECGs. 11,12 Currently, there are no data evaluating the impact of adjunctive IC ␤-blocker therapy before PCI on postprocedural MI, as reflected by biochemical marker release, and on clinical…”

mentioning

confidence: 99%

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Distal Myocardial Protection During Percutaneous Coronary Intervention With an Intracoronary β-Blocker

et al. 2003

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Background-Experimental studies have demonstrated that intravenous ␤-blocker administration before coronary artery occlusion significantly reduces myocardial injury. Clinical studies have shown that intracoronary (IC) propranolol administration before percutaneous coronary intervention (PCI) delays myocardial ischemia. The present study tested the hypothesis that IC propranolol treatment protects ischemic myocardium from myocardial damage and reduces the incidence of myocardial infarction (MI) and short-term adverse outcomes after PCI. Methods and Results-Patients undergoing PCI (nϭ150) were randomly assigned in a double-blind fashion to receive IC propranolol (nϭ75) or placebo (nϭ75). Study drug was delivered before first balloon inflation via an intracoronary catheter with the tip distal to the coronary lesion. Biochemical markers were evaluated through the first 24 hours and clinical outcomes to 30 days. Evidence of MI with creatine kinase-MB elevation after PCI was seen in 36% of placebo and 17% of propranolol patients (Pϭ0.01). Troponin T elevation was seen in 33% of placebo and 13% of propranolol patients (Pϭ0.005). At 30 days, the composite end point of death, postprocedural MI, non-Q-wave MI after PCI hospitalization, or urgent target-lesion revascularization occurred in 40% of placebo versus 18% of propranolol patients (hazard ratio 2.14, 95% CI 1.24 to 3.71, Pϭ0.004). Conclusions-IC

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Section: Discussionsupporting

confidence: 54%

Section: Study Protocolmentioning

confidence: 99%

mentioning

confidence: 99%

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Distal Myocardial Protection During Percutaneous Coronary Intervention With an Intracoronary β-Blocker

et al. 2003

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“…This could not be evaluated in this protocol, but could better be studied by direct coronary injection into the affected left ventricular region. 6 In addition, we studied responses after only one fixed dose of intravenous propranolol designed to produce fl-blockade in most patients. Even more patients may have benefited if multiple incremental doses had been evaluated.…”

Section: Discussionmentioning

confidence: 99%

Effect of propranolol on myocardial ischemia occurring during acute coronary occlusion.

Feldman¹,

Macdonald²,

Hill³

et al. 1986

Circulation

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In 16 patients undergoing angioplasty of the left anterior descending coronary artery, the clinical, electrocardiographic, and hemodynamic effects of short-term intravenous nonselective ,Badrenergic blockade with propranolol (0.1 mg/kg) were assessed during temporary occlusion of the artery. Myocardial ischemia during coronary occlusion was prevented, delayed in onset, or diminished in magnitude by propranolol in 10 of the 16 (j3-adrenergic blockers, calcium antagonists, and long-acting nitrates) were discontinued at least five half-lives before study. Use of sublingual nitroglycerin was permitted until 6 hr before study. In five patients (Nos. 1, 3, 5, 6, and 12) administration of calcium antagonists was continued uninterrupted before the procedure. All patients received 325 mg of aspirin orally the night before the study and 10,000 units of heparin intra-arterially at the beginning of the procedure. No intravenous or intracoronary nitroglycerin was administered until after the research portion of the experiment was completed. All patients gave written informed consent. The study was approved by the appropriate institutional review committees.Angioplasty. Angioplasty of the left anterior descending coronary artery was performed in the usual fashion, except that calcium antagonists and nitrates were omitted (as noted). Briefly, a No. 8F angioplasty sheath (USCI) was placed percutaneously in the right femoral artery, and through it a No. 8F FL4 or FL4G guide catheter was positioned in the ascending aorta. An appropriately sized "steerable" balloon dilation catheter (USCI, 2.5 to 3.5 mm diameter, 25 mm length) was positioned through the guide catheter across the stenosis of the left anterior descending artery so that when inflated ( 1 to 2 atm) the balloon also obstructed any branches proximal to the stenosis. This was confirmed angiographically. From the right femoral vein a catheter was positioned in the pulmonary arterial wedge position to measure left ventricular filling pressure. From the right or left antecubital vein, a multithermistor catheter was positioned in the coronary sinus to measure regional coronary venous flow (thermodilution). The distal thermistor was positioned in the great cardiac vein close to its juncture with the anterior interventricular vein.The balloon dilation catheter usually initially obstructed the left anterior descending artery an amount sufficient to lead to signs or symptoms of myocardial ischemia. In all cases several brief balloon inflations were performed to decrease the magnitude of obstruction. The balloon was then deflated, and pressures, the electrocardiogram, and clinical signs were monitored. None of the patients had clinical, ECG, or hemodynamic evidence of myocardial ischemia for at least 5 min before control period measurements were made.Control period. When all evidence of transient myocardial ischemia was absent for at least 5 min, control period recordings of aortic, distal coronary, and left ventricular filling pressures; ECG leads I, II, and V5; and gr...

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“…Beta-blockers, administered intravenously or intracoronarily, diminish ischemia during acute coronary occlusion in humans [12,13]. Bonnier et al [14] showed that a calcium entry blocker, diltiazem, could reduce oxypurine production from high-energy phosphates, induced by percutaneous transluminal coronary angioplasty (PCTA).…”

mentioning

confidence: 99%

Absence of beneficial effect of intravenous metoprolol given during angioplasty in patients with single-vessel coronary artery disease

Jong

Bonnier

Huizer

et al. 1993

Cardiovasc Drug Ther

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Summary. In a double-blind, randomized, placebo-controlled trial, the possible antiischemic effect of metoprolol during percutaneous transluminal coronary angioplasty was tested. Electrocardiograms, hemodynamics, and metabolism were studied in 27 patients with a stenosis in the left anterior descending coronary artery. Measurements took place before angioplasty, after each of four 1-minute occlusions and 15 minutes after the last balloon deflation. Patients were randomly given placebo or metoprolol (15 mg as a bolus intravenously, followed by an infusion of 0.04 mg/kg/hr). At the end of the procedure, the rate-pressure product had decreased by 15% (NS) and 23% (p = 0.001) in the placebo and metoprolol groups, respectively, mainly due to similar decreases in heart rate. Metoprolol tended to lower chest pain and reduce precordial ST-segment elevation due to angioplasty, but the effects were not statistically significant. Lactate, hypoxanthine, and urate release immediately after deflation was similar in both groups. Metoprolol reduced arterial plasma hypoxanthine throughout the procedure by about 30% (p -< 0.02 vs. placebo). Thus, intravenous infusion of metoprolol did not significantly attenuate chest pain and ST-segment elevation, and failed to decrease cardiac lactate and oxypurine release. It did, however, reduce arterial hypoxanthine concentrations during angioplasty, possibly indicating that the beta-blocker inhibits extracardiac ATP catabolism.

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Myocardial protection during transient coronary artery occlusion in man: beneficial effects of regional beta-adrenergic blockade.

Cited by 89 publications

References 26 publications

Distal Myocardial Protection During Percutaneous Coronary Intervention With an Intracoronary β-Blocker

Distal Myocardial Protection During Percutaneous Coronary Intervention With an Intracoronary β-Blocker

Effect of propranolol on myocardial ischemia occurring during acute coronary occlusion.

Absence of beneficial effect of intravenous metoprolol given during angioplasty in patients with single-vessel coronary artery disease

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