Document Detail

Distal myocardial protection during percutaneous coronary intervention with an intracoronary beta-blocker.
MedLine Citation:
PMID:  12771007     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Experimental studies have demonstrated that intravenous beta-blocker administration before coronary artery occlusion significantly reduces myocardial injury. Clinical studies have shown that intracoronary (IC) propranolol administration before percutaneous coronary intervention (PCI) delays myocardial ischemia. The present study tested the hypothesis that IC propranolol treatment protects ischemic myocardium from myocardial damage and reduces the incidence of myocardial infarction (MI) and short-term adverse outcomes after PCI. METHODS AND RESULTS: Patients undergoing PCI (n=150) were randomly assigned in a double-blind fashion to receive IC propranolol (n=75) or placebo (n=75). Study drug was delivered before first balloon inflation via an intracoronary catheter with the tip distal to the coronary lesion. Biochemical markers were evaluated through the first 24 hours and clinical outcomes to 30 days. Evidence of MI with creatine kinase-MB elevation after PCI was seen in 36% of placebo and 17% of propranolol patients (P=0.01). Troponin T elevation was seen in 33% of placebo and 13% of propranolol patients (P=0.005). At 30 days, the composite end point of death, postprocedural MI, non-Q-wave MI after PCI hospitalization, or urgent target-lesion revascularization occurred in 40% of placebo versus 18% of propranolol patients (hazard ratio 2.14, 95% CI 1.24 to 3.71, P=0.004). CONCLUSIONS: IC administration of propranolol protects the myocardium during PCI, significantly reducing the incidence of MI and improving short-term clinical outcomes.
Fen Wei Wang; Abdulfatah Osman; Javier Otero; George A Stouffer; Sergio Waxman; Adnan Afzal; Angelo Anzuini; Barry F Uretsky
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial     Date:  2003-05-27
Journal Detail:
Title:  Circulation     Volume:  107     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2003 Jun 
Date Detail:
Created Date:  2003-06-19     Completed Date:  2003-07-01     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2914-9     Citation Subset:  AIM; IM    
Department of Internal Medicine, Division of Cardiology, The University of Texas Medical Branch at Galveston, 301 University Blvd, 5.106 JSHA, Galveston, Tex 77555-0553, USA.
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MeSH Terms
Adrenergic beta-Antagonists / administration & dosage*
Angioplasty, Transluminal, Percutaneous Coronary* / adverse effects
Aspirin / administration & dosage
Biological Markers / analysis
Coronary Artery Disease / therapy*
Creatine Kinase / analysis
Creatine Kinase, MB Form
Double-Blind Method
Heart / drug effects
Injections, Intra-Arterial
Isoenzymes / analysis
Middle Aged
Multivariate Analysis
Myocardial Infarction / etiology,  prevention & control*
Platelet Aggregation Inhibitors / administration & dosage
Propranolol / administration & dosage*
Sample Size
Survival Analysis
Treatment Outcome
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Biological Markers; 0/Isoenzymes; 0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin; 525-66-6/Propranolol; EC Kinase; EC Kinase, MB Form
Comment In:
Circulation. 2003 Jun 17;107(23):e9050-1   [PMID:  12814988 ]

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