Distal myocardial protection with intracoronary beta blocker when added to a Gp
IIb/IIIa platelet receptor blocker during percutaneous coronary intervention
improves clinical outcome.
Author(s): Uretsky BF(1), Birnbaum Y, Osman A, Gupta R, Paniagua O, Chamoun A, Pohwani A,
Lui C, Lev E, McGehee T, Kumar D, Akhtar A, Anzuini A, Schwarz ER, Wang FW.
Affiliation(s): Author information:
(1)Division of Cardiology, University of Texas Medical Branch at Galveston,
Texas, USA. buretsky@sparks.org
Publication date & source: 2008, Catheter Cardiovasc Interv. , 72(4):488-97
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.
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