Randomized Study on the Efficacy and Safety of Landiolol, an Ultra-Short-Acting .BETA.1-Adrenergic Blocker, in Patients With Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Abstract

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp s a treatment for acute myocardial infarction (AMI), thrombolytic therapy was started in the early 1980 s, 1 and now the best strategy is reperfusion of the occluded coronary artery and restoration of coronary blood flow with percutaneous coronary intervention (PCI) early after the onset of AMI. 2 Despite the fact that the outcome of AMI has improved with the reperfusion strategy, morbidity and mortality after AMI still remain significant. Editorial p 301Whether pharmacological interventions added to reperfusion therapy can further reduce myocardial damage or improve the prognosis has been investigated for the past 3 decades. 3 Many pharmacologic agents have been administered for cardiac protection, including KATP channel openers, human atrial natriuretic peptide, glucose-insulin-potassium infusion, sodiumhydrogen exchange inhibitors, adenosine receptor agonists, calcium-channel blockers, β-blockers and so on. Beta-blockers reduce myocardial oxygen consumption by decreasing the heart rate (HR) and myocardial contractility, which improves the oxygen supply/demand ratio. 4 It is well known that oral β-blocker therapy improves survival after AMI, especially in patients with reduced cardiac function. 5 However, it remains unclear whether intravenous administration of a β-blocker in the very acute phase of AMI is beneficial. In the pre-thrombolytic era, treatment with intravenous followed by oral administration of β-blocker improved survival and reduced infarct size. 6-8 In the thrombolytic era, early intravenous followed by oral administration of a β-blocker did not affect left ventricular Background: It is still controversial whether intravenous administration of β-blocker in the very acute phase of acute myocardial infarction (AMI) is beneficial. Landiolol is an ultra-short-acting β-blocker that has less effect on blood pressure, but little is known about its efficacy and safety for patients with AMI undergoing primary percutaneous coronary intervention (PCI).

Management and Two-Year Long-Term Clinical Outcome of Acute Coronary Syndrome in Japan

“…Utilization rates of anti-platelet therapy, statin and angiotensin-converting enzyme inhibitor (ACEI)/ angiotensin II receptor blocker (ARB) therapies were as high as previous studies, 12,17 but β-blockers were prescribed to fewer patients when compared to recent reports, although the additive effect of β-blockers on ACEI/ARB has been reported from Japan. [18][19][20][21][22] In addition, 2-year post-discharge observations indicated a potential decrease in adherence to pharmacological therapies. It is well-known that the increase in adherence to treatment guidelines is associated with a lowering of long-term mortality.…”

Safety and Efficacy of a Bolus Injection of Landiolol Hydrochloride as a Premedication for Multidetector-Row Computed Tomography Coronary Angiography

“…6,7 Recent studies have shown landiolol to be safe and effective in patients with perioperative atrial fibrillation or tachycardia, 9,11,13 in patients with severe ventricular arrhythmia 10 or acute decompensated heart failure, 11 and for early initiation of β-blockers in patients with acute myocardial infarction. 12 In addition, Isobe et al reported the usefulness of continuous infusion of landiolol hydrochloride for MDCT CAG. 14 Although continuous infusion of landiolol hydrochloride is reported to be safe, 14 such a procedure seems complicated in an outpatient clinic.…”

Clinical utility of landiolol for use in coronary CT angiography

“…Early intravenous administration of landiolol in patients with acute myocardial infarction undergoing percutaneous coronary intervention could have the potential to improve cardiac function in the chronic phase. 37 An intravenous β-blocker, including landiolol, is effective during electroconvulsive therapy for patients with severe depression. 38 This is because the released catecholamine may last several minutes, which causes tachycardia resulting in coronary ischemia in patients at risk.…”