Key result
Intracoronary BQ-123 before PCI increases postprocedural coronary microvascular flow velocity by ~58% versus placebo.
Why the study?
Does intracoronary BQ-123 improve post-PCI coronary microvascular blood flow in patients with non-ST elevation acute coronary syndromes?
RCT (n=23)
double-blinded
randomised
No
Does intracoronary BQ-123 improve post-PCI coronary microvascular blood flow in patients with non-ST elevation acute coronary syndromes?
Adjunctive selective ETA antagonist BQ-123 administered before PCI in NSTACS patients significantly improves postprocedural coronary microvascular blood flow and reduces myocardial injury.
Answers are grounded in this paper and cite their sources.
Intracoronary BQ-123 improves post-PCI microvascular flow in NSTACS; supports ETA antagonism as adjunctive therapy and warrants outcome trials.
OBJECTIVES: Percutaneous coronary intervention (PCI) for acute coronary syndromes frequently fails to restore myocardial perfusion despite establishing epicardial vessel patency. Endothelin-1 (ET-1) is a potent vasoconstrictor, and its expression is increased in atherosclerosis and after PCI. In this study, we aim to define the role of endothelin in regulating coronary microvascular blood flow and myocardial perfusion following PCI in patients with non-ST elevation acute coronary syndromes (NSTACS), by assessing whether adjunctive therapy with a selective endothelin A (ETA) receptor antagonist acutely improves postprocedural coronary microvascular blood flow. METHODS: In a randomised, double-blinded, placebo-controlled trial, 23 NSTACS patients were enrolled to receive an intracoronary infusion of placebo (n=11) or BQ-123 (n=12) immediately before PCI. Post-PCI coronary microvascular blood flow and myocardial perfusion were assessed by measuring Doppler-derived average peak velocity (APV), and cardiac biomarker levels were quantified. RESULTS: Compared with the placebo group, APV was significantly higher in the drug group immediately after PCI (30 (20, 37) vs 19 (9, 26) cm/s; p=0.03). Hyperaemic APV, measured post-adenosine administration, was higher in the BQ-123 group, but the difference did not achieve statistical significance (56 (48, 72) vs 46 (34, 64) cm/s; p=0.090). Maximum coronary flow reserve postprocedure was not different between the two groups (2.1 (1.6, 2.3) vs 2.5 (1.8, 3.0)). Per cent change in creatine kinase isoenzyme MB from the time of PCI to 8 and 16 hours post-PCI was significantly lower in the drug group compared with the placebo group (-17 (-26, -10) vs 26 (-15, 134); p=0.02 and -17 (-38, 14) vs 107 (2, 446); p=0.007, respectively). CONCLUSIONS: Endothelin is a mediator of microvascular dysfunction during PCI in NSTACS, and adjunctive selective ETA antagonist may augment myocardial perfusion during PCI. TRIAL REGISTRATION NUMBER: NCT00586820; Results.
No takes yet. Share an insight, caveat, or question.
Guddeti et al. (2016) conducted an RCT in non-ST elevation acute coronary syndromes (NSTACS) (n=23). BQ-123 vs. placebo was evaluated on Post-PCI coronary microvascular blood flow (Doppler-derived average peak velocity) (p=0.03).
Synapse has enriched 10 related papers. Consider them for comparative context: