Distal myocardial protection with intracoronary beta blocker when added to a Gp IIb/IIIa platelet receptor blocker during percutaneous coronary intervention improves clinical outcome

Barry F. Uretsky, Yochai Birnbaum, Abdulfatah Osman, Rajiv Gupta, Oscar Paniagua, Antonio Chamoun, Amir Pohwani, Charles Luis, Eli Lev, Todd McGehee, Darren Kumar, Asif Akhtar, Angelo Anzuini, Ernst R. Schwarz, Fen Wei Wang

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Objective: The present study tested the hypothesis that intracoronary (IC) propranolol improves clinical outcomes with percutaneous coronary intervention (PCI) when used with background Gp IIb/IIIa receptor blockade. Background: We have previously shown that administration of a relatively large weight-based IC dose of the beta blocker propranolol before PCI decreases the incidence of post-PCI myocardial infarction (MI) and improves short- and long-term outcome. It has previously been shown that administration of a Gp IIb/IIIa receptor blocker decreases post-PCI MI and improves short- and long-term clinical outcome. Methods: Patients undergoing PCI (n = 400) were randomized in a prospective double-blind fashion to IC propranolol (n = 200) or placebo (n = 200) with eptifibatide administered to all the patients. Myocardial isoform of creatine kinase was measured during the first 24 hr and clinical outcomes at 30 days and 1 year. Results: MI after PCI was seen in 21.5% of placebo and 12.5% of propranolol patients (relative risk reduction 0.42; 95%CI 0.09, 0.63; P = 0.016). At 30 days, the composite end point of death, post-procedural MI, urgent target lesion revascularization, or MI after index hospitalization occurred in 22.5% of placebo vs. 13.5% of propranolol patients (risk reduction 0.43; 95%CI 0.08, 0.65; P = 0.018). Similar results were observed at 1 year with adverse outcomes in 21.5% of propranolol and 32.5% of placebo patients (P = 0.01). Conclusion: IC propranolol administration with the background Gp IIb/ IIIa receptor blockade significantly reduces the incidence of post-PCI MI and improves the short- and long-term clinical outcome when compared with a Gp IIb/ IIIa blocker alone.

Original languageEnglish
Pages (from-to)488-497
Number of pages10
JournalCatheterization and Cardiovascular Interventions
Volume72
Issue number4
DOIs
StatePublished - 1 Oct 2008
Externally publishedYes

Keywords

  • Angioplasty
  • Beta adrenergic blocker
  • Myocardial infarction
  • Myocardial protection

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