Randomized Study on the Efficacy and Safety of Landiolol, an Ultra-Short-Acting β1-Adrenergic Blocker, in Patients With Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

• Published in: Circulation Journal Vol. 76; no. 2; pp. 439 - 445
• Main Authors: Hanada, Kenji, Higuma, Takumi, Nishizaki, Fumie, Sukekawa, Takanori, Yokota, Takashi, Yamada, Masahiro, Saito, Shin, Kushibiki, Motoi, Oikawa, Koichi, Abe, Naoki, Tomita, Hirofumi, Osanai, Tomohiro, Okumura, Ken
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 2012
• Subjects: Acute myocardial infarction; Adrenergic beta-1 Receptor Antagonists - metabolism; Angioplasty, Balloon, Coronary; Beta-blocker; Cardiac function; Combined Modality Therapy; Female; Humans; Injections, Intravenous; Male; Middle Aged; Morpholines - administration & dosage; Morpholines - adverse effects; Myocardial Infarction - drug therapy; Myocardial Infarction - mortality; Prospective Studies; Remodeling; Stroke Volume - drug effects; Treatment Outcome; Urea - administration & dosage; Urea - adverse effects; Urea - analogs & derivatives; Ventricular Remodeling - drug effects
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.CJ-11-0947

Background: It is still controversial whether intravenous administration of β-blocker in the very acute phase of acute myocardial infarction (AMI) is beneficial. Landiolol is an ultra-short-acting β-blocker that has less effect on blood pressure, but little is known about its efficacy and safety for patients with AMI undergoing primary percutaneous coronary intervention (PCI). Methods and Results: A consecutive 96 patients with AMI not manifesting cardiogenic shock were prospectively randomized to landiolol (n=47) or a control group (n=49). Continuous administration of landiolol (3μg·kg-1·min-1 for 24h) was done just after PCI in the landiolol group, but not in the control group. Heart rate decreased by 9.4±1.7beats/min after initiation of landiolol (P<0.01), but was unchanged in the control group. Left ventricular ejection fraction assessed 6 months later was greater than that at 2 weeks in the landiolol group (52.0±1.5 vs. 49.1±1.5%, P=0.01), but remained unchanged in the control group. Left ventricular end-diastolic volume index assessed 6 months later was increased compared with that at 2 weeks in the control group (78.0±2.7 vs. 72.5±2.8ml/m2, P=0.02), whereas it was unchanged in the landiolol group. Conclusions: Early intravenous administration of landiolol in patients with AMI undergoing PCI is safe and has the potential to improve cardiac function and inhibit cardiac remodeling in the chronic phase. (Circ J 2012; 76: 439-445)