Randomized Control of Sympathetic Drive With Continuous Intravenous Esmolol in Patients With Acute ST-Segment Elevation Myocardial Infarction

Er, Fikret; Dahlem, Kristina M.; Nia, Amir M.; Erdmann, Erland; Waltenberger, Johannes; Hellmich, Martin; Kuhr, Kathrin; Lê, Minh Tâm; Herrfurth, Tina; Taghiyev, Z.; Biesenbach, Esther; Yüksel, Dilek; Eran-Ergöknil, Aslihan; Vanezi, Maria; Caglayan, Evren; Gassanov, Natig

doi:10.1016/j.jcin.2015.10.035

Cited by 49 publications

(43 citation statements)

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“…It is currently widely believed that activation of the RAAS and SNS systems is associated with adverse prognosis. [18–21] Yoichi et al reported that BUN/Cr, but not BUN or Cr individually, is linked with an increased risk of mortality in AHF patients. [4] Gotsman et al also believed that in patients with AHF, admission BUN/Cr was a predictor of worse 1-year and long-term (mean follow-up of 6.5 years) mortality.…”

Section: Discussionmentioning

confidence: 99%

Predictive value of blood urea nitrogen/creatinine ratio in the long-term prognosis of patients with acute myocardial infarction complicated with acute heart failure

2019

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At present, the long-term prognosis of patients with acute myocardial infarction (AMI) after emergency percutaneous coronary intervention is the focus of attention, and relevant research is actively investigating the risk factors associated with prognosis. Poor prognosis often exists in Patients with AMI complicated with acute heart failure (AHF). In recent years, some studies have found that blood urea nitrogen/creatinine ratio (BUN/Cr) can better predict the prognosis of patients with AHF than single BUN or Cr. The relationship between long-prognosis of patients with AMI, as one of the common causes of AHF, and BUN/Cr is unknown. The main purpose of this study was to determine whether BUN/Cr has a predictive value for long-term prognosis in patients with AMI complicated with AHF.In this study, 389 consecutive patients with AMI were enrolled. According to AHF and a median BUN/Cr at admission of 15.32, the patients were divided into four groups (non-AHF + low BUN/Cr, non-AHF + high BUN/Cr, AHF + low BUN/Cr, and AHF + high BUN/Cr groups). A 1-year follow-up was implemented, and the study endpoint was defined as all-cause mortality. Predictors associated with 1-year mortality were evaluated using the Cox proportional hazard analysis, and the Kaplan–Meier analysis was used to estimate the survival rates.AHF occurred in 163 patients (41.9%) during hospital admission and 29 patients died during the 1-year follow-up. The Cox proportional hazard analysis proved an association between the combination of AHF and high BUN/Cr and mortality; however, the association with AHF + low BUN/Cr was not statistically significant.AHF combined with elevated BUN/Cr is linked with an increased risk of mortality in patients with AMI, which suggests that BNU/Cr has a predictive value for prognosis in patients with AMI complicated with AHF.

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Section: Discussionmentioning

confidence: 99%

Predictive value of blood urea nitrogen/creatinine ratio in the long-term prognosis of patients with acute myocardial infarction complicated with acute heart failure

2019

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“…235 Two different mitochondria-targeting drugs 236,237 failed to reduce infarct size or to improve coronary microvascular function. Currently, only 4 drugs stand unchallenged to provide cardioprotection in term of infarct size reduction: atrial natriuretic peptide, 238 metoprolol, 32 esmolol, 239 and exenatide, [240][241][242] and no information on coronary microvascular function is available for these drugs.…”

Section: Clinical Studiesmentioning

confidence: 99%

The Coronary Circulation as a Target of Cardioprotection

Heusch

2016

Circulation Research

209

160

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Abstract:The atherosclerotic coronary vasculature is not only the culprit but also a victim of myocardial ischemia/ reperfusion injury. Manifestations of such injury are increased vascular permeability and edema, endothelial dysfunction and impaired vasomotion, microembolization of atherothrombotic debris, stasis with intravascular cell aggregates, and finally, in its most severe form, capillary destruction with hemorrhage. In animal experiments, local and remote ischemic pre-and postconditioning not only reduce infarct size but also these manifestations of coronary vascular injury, as do drugs which recruit signal transduction steps of conditioning. Clinically, no-reflow is frequently seen after interventional reperfusion, and it carries an adverse prognosis. The translation of cardioprotective interventions to clinical practice has been difficult to date. Only 4 drugs (brain natriuretic peptide, exenatide, metoprolol, and esmolol) stand unchallenged to date in reducing infarct size in patients with reperfused acute myocardial infarction; unfortunately, for these drugs, no information on their impact on the ischemic/reperfused coronary circulation is available. (Circ Res.

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“…Mechanically, it is also plausible that the hemodynamic effects of morphine; reducing heart rate, decreasing blood pressure, and reducing venous return through venodilatation, might be beneficial in STEMI patients, where elevated sympathetic drive can be significant and detrimental . In unadjusted outcomes, mortality rates were lower in STEMI patients who received morphine and our study may have been underpowered to truly assess this clinical endpoint.…”

Section: Discussionmentioning

confidence: 99%

In‐hospital outcomes in invasively managed acute myocardial infarction patients who receive morphine

McCarthy

Bhambhani

Pomerantsev

et al. 2017

J Interven Cardiology

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Randomized Control of Sympathetic Drive With Continuous Intravenous Esmolol in Patients With Acute ST-Segment Elevation Myocardial Infarction

Abstract: Esmolol treatment statistically significantly decreased troponin T, CK, CK-MB and NT-proBNP release as surrogate markers for myocardial injury in patients with STEMI. (Heart Rate Control After Acute Myocardial Infarction; DRKS00000766).

Cited by 49 publications

References 44 publications

Predictive value of blood urea nitrogen/creatinine ratio in the long-term prognosis of patients with acute myocardial infarction complicated with acute heart failure

Predictive value of blood urea nitrogen/creatinine ratio in the long-term prognosis of patients with acute myocardial infarction complicated with acute heart failure

The Coronary Circulation as a Target of Cardioprotection

In‐hospital outcomes in invasively managed acute myocardial infarction patients who receive morphine

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