Distal Myocardial Protection With Intracoronary Beta Blocker When Added to a Gp IIb/IIIa Platelet Receptor Blocker During Percutaneous Coronary Intervention Improves Clinical Outcome

作者：Uretsky Barry F^*; Birnbaum Yochai; Osman Abdulfatah; Gupta Rajiv; Paniagua Oscar; Chamoun Antonio; Pohwani Amir; Lui Charles; Lev Eli; McGehee Todd; Kumar Darren; Akhtar Asif; Anzuini Angelo; Schwarz Ernst R; Wang Fen Wei

来源：Catheterization and Cardiovascular Interventions, 2008, 72(4): 488-497.

DOI：10.1002/ccd.21677

• angioplasty
• myocardial protection
• beta adrenergic blocker
• myocardial infarction

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.

• 出版日期2008-10-1