Abstract 2638: Intracoronary Beta Blockade (BB) During Percutaneous Coronary Intervention (PCI): 30 Day Results of the Randomized Angioplasty Beta Blocker Intracoronary Trial II (RABBIT II)
Background: Myocardial infarction (MI) after percutaneous coronary intervention (PCI) is associated with worsened late patient outcome. We previously showed in a prospective randomized double blind trial that intracoronary (IC) propranolol (0.015 mg/kg) to the at-risk myocardium distal to the lesion prior to PCI without obligate background usage of a Gp IIb/IIIa inhibitor (Gp) decreased MI incidence as evidenced by an elevation in CKMB and improved short- (30d) and long (one year)term patient outcome.
Objective: To determine if IC propranolol is effective in decreasing post-PCI MI frequency and short-term adverse outcome with obligate background Gp use.
Method: We performed a prospective, randomized, double-blind, placebo (PL)-controlled trial in 400 non-emergency PCI patients (200/group) using the same methodology as our previous study with the exception that all patients received eptifibatide using the ESPRIT dosing protocol.
Results: The composite end point of death, post-PCI MI, MI after index PCI hospitalization, or target lesion revascularization (TLR) through the first 30 days was decreased with IC propranolol compared with PL (figure⇓). At 30 day, the incidence of the composite end point was 22.5% in the PL and 13.5% in the propranolol group (p=0.01). Individual components were as follows: post PCI MI 21.5% PL vs. 12.5% BB (p=0.016); mortality 0.5% PL vs. 0% BB; TLR 1.5% PL vs. 1% BB; MI after index PCI hospitalization 1% PL vs. 2.5% BB.
Conclusion: This study confirms that IC propranolol decreases post-PCI MI and 30 day composite adverse patient outcome and also extends this finding by demonstrating its efficacy in patients on background Gp IIb/IIIa platelet inhibition.