Abstract 10337: Using Landiolol During Primary Percutaneous Coronary Intervention Attenuates Myocardial Reperfusion Injury in Patients With ST-segment Elevation Acute Myocardial Infarction

Introduction: Landiolol is the beta-1 selective receptor blocker and its half-life elimination is 4 minutes. The safety and efficacy of landiolol started before coronary reperfusion in patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) remains unclear. We assessed the hypothesis that early use of landiolol promotes optimal reperfusion without increasing adverse events for those patients. Methods: We recruited 220 consecutive patients with STEMI performed pPCI. Patients with heart rate<50, Killip class≧2, old myocardial infarction and 2 or 3 degree of AV-block on admission were excluded. 60 patients were non-landiolol group with conventional treatment admitted from October 2010 to September 2012. 55 patients were landiolol group admitted from October 2012 to September 2014. Administration of landiolol was started before pPCI with 3 μg/kg/min and stopped within 12 hours when oral beta-blockers were administered. ST-segment resolution (STR) was defined as more than 70% resolution of sum of ST-segment elevation at the J point between at the time of admission and just after pPCI. Result: Time form admission to stating landiolol was 35±23min in landiolol group. Age, sex, coronary risk factors, culprit lesion, SYNTAX score (19±10vs18±10) and reperfusion time did not differ between the two groups (all NS). The rate of non-sustained ventricular tachycardia (27vs50%, p=0.013), worsening heart failure (0vs8%, p=0.029) and shock (15vs31%, p=0.030) within 12 hours after the admission was lower in landiolol group. Although, at the time of finishing pPCI, systric blood pressure did not differ between the two groups (117±21vs124±24mmHg, p=0.09), heart rate was lower (66±11vs77±14/min, p<0.01) and the rate of STR was higher (61vs42%, p=0.023) in landiolol group. Multivariate analysis showed that landiolol use was an independent predictor of STR (OR2.51, p=0.045). Within 6 months after the admission, the rate of worsening heart failure (0vs7%, p=0.07), target vessel revasculization (5vs10%, p=0.17) was lower in landiolol group. Conclusion: In low risk patients with STEMI, using landiolol during pPCI may attenuate myocardial reperfusion injury and reduce adverse events.