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Absence of beneficial effect of intravenous metoprolol given during angioplasty in patients with single-vessel coronary artery disease

  • Coronary Artery Disease
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Summary

In a double-blind, randomized, placebo-controlled trial, the possible antiischemic effect of metoprolol during percutaneous transluminal coronary angioplasty was tested. Electrocardiograms, hemodynamics, and metabolism were studied in 27 patients with a stenosis in the left anterior descending coronary artery. Measurements took place before angioplasty, after each of four 1-minute occlusions and 15 minutes after the last balloon deflation. Patients were randomly given placebo or metoprolol (15 mg as a bolus intravenously, followed by an infusion 0.04 mg/kg/hr). At the end of the procedure, the rate-pressure product had decreased by 15% (NS) and 23% (p=0.001) in the placebo and metoprolol groups, respectively, mainly due to similar decreases in heart rate. Metoprolol tended to lower chest pain and reduce precordial ST-segment elevation due to angioplasty, but the effects were not statistically significant. Lactate, hypoxanthine, and urate release immediately after deflation was similar in both groups. Metoprolol reduced arterial plasma hypoxanthine throughout the procedure by about 30% (p ≦ 0.02 vs. placebo). Thus, intravenous infusion of metoprolol did not significantly attenuate chest pain and ST-segment elevation, and failed to decrease cardiac lactate and oxypurine release. It did, however, reduce arterial hypoxanthine concentrations during angioplasty, possibly indicating that the beta-blocker inhibits extracardiac ATP catabolism.

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Authors and Affiliations

  1. FESC, Cardiochemical Laboratory/Thoraxcentre, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands

    Jan Willem de Jong PhD, Tom Huizer & Jos R. T. C. Roelandt

  2. Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands

    Johannes J. R. M. Bonnier & Renzo Ciampricotti

Authors
  1. Jan Willem de Jong PhD
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  2. Johannes J. R. M. Bonnier
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  3. Tom Huizer
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  4. Renzo Ciampricotti
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  5. Jos R. T. C. Roelandt
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de Jong, J.W., Bonnier, J.J.R.M., Huizer, T. et al. Absence of beneficial effect of intravenous metoprolol given during angioplasty in patients with single-vessel coronary artery disease. Cardiovasc Drug Ther 7, 677–682 (1993). https://doi.org/10.1007/BF00877821

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  • DOI: https://doi.org/10.1007/BF00877821

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