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Pretreatment with intracoronary enalaprilat protects human myocardium during percutaneous coronary angioplasty.

Abstract：

OBJECTIVES:We tested the hypothesis that enalaprilat induces preconditioning (PC)-mimetic actions in patients with stable coronary artery disease. BACKGROUND:Angiotensin-converting enzyme (ACE) inhibitors increase the bioavailability of bradykinin, which induces cardiac PC. METHODS:Twenty-two patients undergoing coronary angioplasty were randomized to an intracoronary infusion of enalaprilat or placebo, followed 10 min later by a PC protocol. RESULTS:In control patients, the ST-segment shift was greater during the first inflation than during the second and third inflations, both on the intracoronary electrocardiogram (ECG) (21.0 +/- 2.8 mm vs. 13.0 +/- 2.0 mm and 13.0 +/- 2.0 mm, p < 0.05) and the surface ECG (16.0 +/- 4.0 mm vs. 10.0 +/- 2.0 mm and 9.0 +/- 2.0 mm, p < 0.05). In contrast, enalaprilat-pretreated patients showed no change in ST-segment shift during inflations on either the intracoronary or the surface ECG. During the first inflation, the ST-segment shift was significantly smaller in treated versus control patients. The chest pain score during the first inflation was also significantly smaller in treated patients versus control patients (33.0 +/- 6.0 mm vs. 64.0 +/- 6.0 mm) and did not change in treated patients during the second and third inflations, whereas it decreased significantly in control patients. In a subset of 6 patients, enalaprilat increased coronary blood flow during infusion, but this effect dissipated before the beginning of angioplasty. CONCLUSIONS:Pretreatment with enalaprilat attenuates the manifestations of myocardial ischemia during angioplasty. This is the first in vivo evidence showing that an ACE inhibitor protects human myocardium, possibly via PC-mimetics actions, a novel property that might explain the cardioprotective actions of these drugs.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Leesar MA,Jneid H,Tang XL,Bolli R

doi

10.1016/j.jacc.2007.01.060

subject

Has Abstract

pub_date

2007-04-17 00:00:00

pages

1607-1610

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(07)00437-8

journal_volume

pub_type

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Pretreatment with intracoronary enalaprilat protects human myocardium during percutaneous coronary angioplasty.