Intracoronary followed by intravenous administration of the short-acting β-blocker landiolol prevents myocardial injury in the face of elective percutaneous coronary intervention

BackgroundMyocardial injury during elective percutaneous coronary intervention (PCI) is associated with higher subsequent cardiac events and mortality. β-Blockers have been used to reduce myocardial injury during ischemia and reperfusion. We investigated whether intracoronary followed by intravenous administration of the short-acting β-blocker landiolol prevents myocardial injury in the face of elective PCI.Methods and resultsPatients undergoing elective PCI (n = 70) were randomly assigned to the landiolol (n = 35) or control (n = 35) group. Landiolol or saline was administered into target vessels through a balloon catheter for 1 min before and after first balloon inflation followed by continuous intravenous administration for 6 h after PCI. The incidence of myocardial injury defined by cardiac troponin-I (cTnI) ≧ 0.05 ng/ml was 79% of the patients in the control group compared to 56% in the landiolol group (p = 0.04). The cTnI level at 24 h after PCI tended to be lower in the landiolol group (0.57 ± 1.14 versus 1.27 ± 2.48 ng/ml; p = 0.07), while the CK-MB level was not significantly different between the landiolol and control groups. The incidence of peri-procedural myocardial infarction defined by cTnI ≧ 0.12 ng/ml was significantly (p = 0.02) lower in the landiolol group (41%) compared to the control group (70%). There was no incidence of coronary spasm, hypotension, bradycardia or heart failure during and after PCI in the two groups.ConclusionsBrief intracoronary followed by continuous intravenous administration of landiolol is safe and effective for myocardial protection in the face of elective PCI.