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Distal myocardial protection with intracoronary beta blocker when added to a Gp IIb/IIIa platelet receptor blocker during percutaneous coronary intervention improves clinical outcome
Author(s) -
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
Publication year - 2008
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.21677
Subject(s) - medicine , percutaneous coronary intervention , conventional pci , myocardial infarction , propranolol , cardiology , beta blocker , placebo , eptifibatide , anesthesia , heart failure , alternative medicine , pathology
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. © 2008 Wiley‐Liss, Inc.