European Journal of Clinical Pharmacology

, Volume 70, Issue 5, pp 527–530 | Cite as

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
Clinical Trial

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.

Keywords

acute myocardial infarction esmolol milrinone reperfusion injury 

Notes

Acknowledgments

This study was supported in part by the American Heart Association National Scientist Development Grant (to MH). We thank Dr. Barry Uretsky for his critical review and helpful comments on this work.

Conflict of interest

Drs. Ming-He Huang and Kenichi Fujise hold a patent (US8415384B2) related to this study.

Supplementary material

228_2014_1650_MOESM1_ESM.doc (56 kb)
ESM 1 (DOC 56 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Kian-Keong Poh
    • 1
    • 2
  • Xin Xu
    • 3
  • Mark Y. Chan
    • 1
    • 2
  • Chi-Hang Lee
    • 1
    • 2
  • Edgar L. Tay
    • 1
    • 2
  • Adrian F. Low
    • 1
    • 2
  • Koo Hui Chan
    • 1
    • 2
  • Winnie Sia
    • 1
  • Liang-Qiu Tang
    • 3
  • Huay Cheem Tan
    • 1
    • 2
  • Charles Y. Lui
    • 4
  • Vincent Nguyen
    • 5
  • Kenichi Fujise
    • 5
  • Ming-He Huang
    • 5
    • 6
  1. 1.Cardiac Department, National University Heart CenterNational University Health SystemSingaporeSingapore
  2. 2.Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
  3. 3.Yuebei People’s Hospital, Shantou University Medical CenterShaoguanPeople’s Republic of China
  4. 4.University of Utah VA HospitalSalt Lake CityUSA
  5. 5.Department of Internal Medicine, Cardiology DivisionUniversity of Texas Medical BranchGalvestonUSA
  6. 6.Gulf Coast Heart ClinicLeague CityUSA

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