Beneficial effect of early infusion of landiolol, a very short-acting beta-1 adrenergic receptor blocker, on reperfusion status in acute myocardial infarction. (15th October 2016)

• Record Type: Journal Article
• Authors: Kiyokuni, Masayoshi; Konishi, Masaaki; Sakamaki, Kentaro; Kawashima, Chika; Narikawa, Masatoshi; Doi, Hiroshi; Iwata, Kiwamu; Tomari, Sakie; Nakayama, Naoki; Komura, Naohiro; Mitsuhashi, Takayuki; Yano, Hideto; Sugano, Teruyasu; Ishigami, Tomoaki; Endo, Tsutomu; Ishikawa, Toshiyuki; Yamanaka, Takeharu; Kimura, Kazuo
• Is Part Of: International journal of cardiology. Volume 221(2016)
• Page Start: 321
• Page End: 326
• Publication Date: 2016-10-15
• Subjects: ACS Acute coronary syndrome -- AV block Atrioventricular block -- CCU Coronary care unit -- CK Creatinine kinase -- MB Myoglobin binding -- PCI Percutaneous coronary intervention -- STEMI ST-segment elevation myocardial infarction -- STR ST-segment resolution -- SYNTAX SYNergy between PCI with TAXUS™ and Cardiac Surgery -- TIMI thrombolysis in myocardial infarction -- VT Ventricular tachycardia; Acute myocardial infarction -- Adrenergic beta-antagonist -- Percutaneous coronary intervention -- Reperfusion injury -- Prognosis; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.07.076
• Languages: English
• ISSNs: 0167-5273

Abstract

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. Conclusion: 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.