Document Detail


Pretreatment with intracoronary enalaprilat protects human myocardium during percutaneous coronary angioplasty.
MedLine Citation:
PMID:  17433950     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We tested the hypothesis that enalaprilat induces preconditioning (PC)-mimetic actions in patients with stable coronary artery disease. BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitors increase the bioavailability of bradykinin, which induces cardiac PC. METHODS: Twenty-two patients undergoing coronary angioplasty were randomized to an intracoronary infusion of enalaprilat or placebo, followed 10 min later by a PC protocol. RESULTS: In control patients, the ST-segment shift was greater during the first inflation than during the second and third inflations, both on the intracoronary electrocardiogram (ECG) (21.0 +/- 2.8 mm vs. 13.0 +/- 2.0 mm and 13.0 +/- 2.0 mm, p < 0.05) and the surface ECG (16.0 +/- 4.0 mm vs. 10.0 +/- 2.0 mm and 9.0 +/- 2.0 mm, p < 0.05). In contrast, enalaprilat-pretreated patients showed no change in ST-segment shift during inflations on either the intracoronary or the surface ECG. During the first inflation, the ST-segment shift was significantly smaller in treated versus control patients. The chest pain score during the first inflation was also significantly smaller in treated patients versus control patients (33.0 +/- 6.0 mm vs. 64.0 +/- 6.0 mm) and did not change in treated patients during the second and third inflations, whereas it decreased significantly in control patients. In a subset of 6 patients, enalaprilat increased coronary blood flow during infusion, but this effect dissipated before the beginning of angioplasty. CONCLUSIONS: Pretreatment with enalaprilat attenuates the manifestations of myocardial ischemia during angioplasty. This is the first in vivo evidence showing that an ACE inhibitor protects human myocardium, possibly via PC-mimetics actions, a novel property that might explain the cardioprotective actions of these drugs.
Authors:
Massoud A Leesar; Hani Jneid; Xian-Liang Tang; Roberto Bolli
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural     Date:  2007-04-02
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  49     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-04-16     Completed Date:  2007-05-01     Revised Date:  2007-12-03    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1607-10     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, University of Louisville, Louisville, Kentucky 40292, USA.
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MeSH Terms
Descriptor/Qualifier:
Angina Pectoris / diagnosis*,  drug therapy*,  therapy
Angioplasty, Transluminal, Percutaneous Coronary / methods*
Angiotensin-Converting Enzyme Inhibitors / administration & dosage*
Chi-Square Distribution
Chronic Disease
Coronary Angiography
Coronary Circulation / drug effects
Electrocardiography
Enalaprilat / administration & dosage*
Female
Follow-Up Studies
Humans
Infusions, Intralesional
Ischemic Preconditioning, Myocardial / methods
Male
Middle Aged
Probability
Reference Values
Risk Assessment
Severity of Illness Index
Treatment Outcome
Vascular Patency / drug effects
Grant Support
ID/Acronym/Agency:
HL-55757/HL/NHLBI NIH HHS; HL-68088/HL/NHLBI NIH HHS; HL-70897/HL/NHLBI NIH HHS; HL-76794/HL/NHLBI NIH HHS; HL-78825/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 84680-54-6/Enalaprilat

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