Abstract 11571: Beneficial Effect of Early Infusion of Landiolol; A Very Short Acting Beta1 Adrenergic Receptor Blocker, on Reperfusion Status in Acute Myocardial Infarction
Introduction: Landiolol is the beta-1 selective receptor blocker and its half-life elimination is 4 minutes. The safety and efficacy of landiolol started before coronary reperfusion in patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) remains unclear. We assessed the hypothesis that very early use of landiolol promotes optimal reperfusion without increasing adverse events for those patients.
Methods: We conducted a prospective, single-group trial of landiolol during the pPCI for a STEMI. Landiolol was started intravenously just before the pPCI with 3 μg/kg/min. The reperfusion status and clinical outcomes in 55 treated patients were compared with those in 60 historical control patients treated without landiolol. The optimal reperfusion was assessed by an ST-segment resolution (STR), coronary flow, myocardial brush grade (MBG) and peak creatine kinase (CK) after reperfusion.
Result: Time from admission to starting landiolol was 35±23min in landiolol group. Age, sex, coronary risk factors, culprit lesion, SYNTAX score and reperfusion time did not differ between landiolol group and control group (all NS). Those 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 and peak CK were comparable between the two groups. A multivariate analysis showed that landiolol use was an independent predictor of an STR (OR 2.99, 95% CI 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) during admission were lower in the landiolol group. Within 12 months after the admission, the rate of worsening heart failure (0vs7%, p=0.07) tended to be lower in landiolol group. Left ventricular ejection fraction and end-diastolic volume index in 12 months after the admission did not differ between the two groups (landiolol group vs control group: 59±11%vs56±15%, p=0.23; 60±14vs63±30ml/m2, p=0.62).
Conclusion: In patients with STEMI, intra-procedural landiolol in pPCI may attenuate myocardial reperfusion injury and reduce adverse events.
- Myocardial infarction, STEMI
- Percutaneous coronary intervention (PCI)
Author Disclosures: M. Kiyokuni: None. T. Kino: None. M. Kagimoto: None. N. Yamada: None. K. Iwata: None. N. Nakayama: None. K. Takano: None. N. Komura: None. M. Nitta: None. T. Sugano: None. T. Endo: None. T. Ishigami: None. T. Ishikawa: None. K. Kimura: None.
- © 2016 by American Heart Association, Inc.