Safety of combination therapy with milrinone and esmolol for heart protection during percutaneous coronary intervention in acute myocardial infarction

Kian Keong Poh, Xin Xu, Mark Y. Chan, Chi Hang Lee, Edgar L. Tay, Adrian F. Low, Koo Hui Chan, Winnie Sia, Liang Qiu Tang, Huay Cheem Tan, Charles Y. Lui, Vincent Nguyen, Kenichi Fujise, Ming He Huang

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

Purpose: Ischemia/reperfusion injury remains an untreated clinical problem in patients with acute myocardial infarction (AMI) despite significant advances in emergent revascularization through percutaneous coronary intervention (PCI). Pharmacological intervention for infarct size reduction is unavailable. We have identified that the medications milrinone and esmolol, when administered together at the beginning of the reperfusion, significantly decrease infarct size via reducing reperfusion injury in an experimental model. The present study tested the safety of combination therapy of milrinone and esmolol (M + E) in patients with AMI. Methods: Sixteen subjects with AMI requiring PCI were consecutively recruited. M + E was intravenously infused simultaneously for 10 min started at 5 min before anticipated angioplasty balloon inflation. Another 16 consecutively recruited AMI patients requiring PCI served as a placebo arm treated per routine clinical protocol. Blood pressure (BP) and heart rate (HR) were monitored continuously during PCI. Results: M + E combination therapy resulted in a trend of non-significant reduction in BP compared with a control group. There was a modest but significant increase in HR at the later phase of M + E infusion compared with a control group. No significant cardiac arrhythmia was induced during M + E infusion. Conclusions: The combination therapy with M + E produces a minimal change in hemodynamics and appears safe as an adjunctive therapy to PCI in AMI patients. Further studies are warranted.

Original languageEnglish (US)
Pages (from-to)527-530
Number of pages4
JournalEuropean Journal of Clinical Pharmacology
Volume70
Issue number5
DOIs
StatePublished - Jan 1 2014

Keywords

  • acute myocardial infarction
  • esmolol
  • milrinone
  • reperfusion injury

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

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    Poh, K. K., Xu, X., Chan, M. Y., Lee, C. H., Tay, E. L., Low, A. F., Chan, K. H., Sia, W., Tang, L. Q., Tan, H. C., Lui, C. Y., Nguyen, V., Fujise, K., & Huang, M. H. (2014). Safety of combination therapy with milrinone and esmolol for heart protection during percutaneous coronary intervention in acute myocardial infarction. European Journal of Clinical Pharmacology, 70(5), 527-530. https://doi.org/10.1007/s00228-014-1650-9