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

Background: Myocardial injury during elective percutaneous coronary intervention (PCI) is associated with higher subsequent cardiac events and mortality. beta-Blockers have been used to reduce myocardial injury during ischemia and reperfusion. We investigated whether intracoronary followed by intravenous administration of the short-acting beta-blocker landiolol prevents myocardial injury in the face of elective PCI. Methods and results: Patients 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 periprocedural 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. Conclusions: Brief intracoronary followed by continuous intravenous administration of landiolol is safe and effective for myocardial protection in the face of elective PCI. (C) 2012 Elsevier Ireland Ltd. All rights reserved.