Intravenous esmolol is well tolerated in elderly patients with heart failure in the early phase of Non-ST elevation myocardial infarction

• Published in: Drugs & aging Vol. 23; no. 8; pp. 673 - 680
• Main Authors: KOUTOUZIS, Michael, NIKOLIDAKIS, Savvas, GRIGORIADIS, Anestis, KOUTSOGEORGIS, Dimitrios, KYRIAKIDES, Zenon S
• Format: Journal Article
• Language: English
• Published: Auckland Adis International 01.01.2006; Wolters Kluwer Health, Inc
• Subjects: Adrenergic beta-Antagonists - administration & dosage; Adrenergic beta-Antagonists - adverse effects; Adrenergic beta-Antagonists - therapeutic use; Adult; Age Factors; Aged; Aged, 80 and over; Aging; Atrial Function, Right - drug effects; Biological and medical sciences; Blood Pressure - drug effects; Cardiology. Vascular system; Coronary heart disease; Female; Heart; Heart Failure - complications; Heart Failure - drug therapy; Heart Failure - physiopathology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Heart Rate - drug effects; Humans; Infusions, Intravenous; Male; Medical sciences; Middle Aged; Myocardial Infarction - complications; Myocardial Infarction - drug therapy; Myocardial Infarction - physiopathology; Myocarditis. Cardiomyopathies; Propanolamines - administration & dosage; Propanolamines - adverse effects; Propanolamines - therapeutic use; Pulmonary Wedge Pressure - drug effects; Stroke Volume - drug effects; Vascular Resistance - drug effects; Human; Myocardial infarction; Heart failure; Intravenous administration; Toxicity; Esmolol; Early phase; Cardiovascular disease; Patient; Review; Antiarrhythmic agent; Myocardial disease; ST elevation; β1-Adrenergic receptor; Treatment; Heart disease; Antihypertensive agent; Antagonist; Hemodynamics; Elderly; Beta blocking agent
• ISSN: 1170-229X; 1179-1969
• DOI: 10.2165/00002512-200623080-00004

To investigate the haemodynamic response to and clinical safety and tolerability of intravenous esmolol (Brevibloc), Baxter Healthcare Corporation, Deerfield, Illinois, USA) in elderly and younger patients with acute non-ST elevation myocardial infarction (NSTEMI) and heart failure. We studied 24 consecutive patients, 12 of them elderly (> or =75 years old) and 12 younger (32-74 years old), with NSTEMI and symptoms of heart failure on presentation. After stabilisation of the patient's condition with standard therapy, intravenous esmolol was administered. An infusion rate of 0.05 mg/kg/min for 30 minutes was instituted and, if no adverse effects developed, this was increased to 0.20 mg/kg/min. All haemodynamic parameters were measured before and at the end of each administration using a Swan-Ganz catheter. Only one patient in the elderly subgroup did not tolerate the augmented infusion rate (because of severe bradycardia) and so had to return to the initial lower infusion rate. The cardiac index (mean +/- SD) was 2.4 +/- 0.9 L/min/m(2) at baseline and decreased to 1.9 +/- 0.4 L/min/m(2) (p < 0.05 vs baseline) at the end of the administration of the second dose of esmolol in the elderly patients and 2.6 +/- 0.5 L/min/m(2) and 2.2 +/- 0.5 L/min/m(2) (p < 0.05 vs baseline), respectively, in the younger patients. Mean pulmonary wedge pressure was 17 +/- 6mm Hg at baseline and increased to 19 +/- 4mm Hg (p < 0.05 vs baseline) at the end of the second dose of esmolol in the elderly patients and 16 +/- 10mm Hg and 18 +/- 10mm Hg (p < 0.05 vs baseline), respectively, in the younger patients. The response of both age groups to esmolol was the same for all of the parameters examined. Intravenous esmolol was safe and well tolerated in the early phase of NSTEMI in patients presenting with symptoms of heart failure and ongoing ischaemia, regardless of their age.