Poh Kian-Keong, Xu Xin, Chan Mark Y, Lee Chi-Hang, Tay Edgar L, Low Adrian F, Chan Koo Hui, Sia Winnie, Tang Liang-Qiu, Tan Huay Cheem, Lui Charles Y, Nguyen Vincent, Fujise Kenichi, Huang Ming-He
Cardiac Department, National University Heart Center, National University Health System, 1E Kent Ridge Rd, NUHS Tower Block, Level 9, Singapore, 19228, Singapore,
Eur J Clin Pharmacol. 2014 May;70(5):527-30. doi: 10.1007/s00228-014-1650-9. Epub 2014 Jan 25.
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.
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.
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.
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.
尽管经皮冠状动脉介入治疗（PCI）在急诊血管重建方面取得了显著进展，但缺血/再灌注损伤仍是急性心肌梗死（AMI）患者未得到治疗的临床问题。目前尚无减少梗死面积的药物干预措施。我们已经确定，米力农和艾司洛尔在再灌注开始时联合使用，可通过减少实验模型中的再灌注损伤，显著减小梗死面积。本研究测试了米力农和艾司洛尔联合治疗（M+E）在AMI患者中的安全性。
连续招募16例需要进行PCI的AMI患者。在预计血管成形术球囊扩张前5分钟开始，将M+E同时静脉输注10分钟。另外连续招募16例需要进行PCI的AMI患者作为安慰剂组，按照常规临床方案进行治疗。在PCI过程中持续监测血压（BP）和心率（HR）。
与对照组相比，M+E联合治疗导致血压有非显著性降低的趋势。与对照组相比，在M+E输注后期心率有适度但显著的增加。在M+E输注过程中未诱发明显的心律失常。
M+E联合治疗对血流动力学的影响极小，作为AMI患者PCI的辅助治疗似乎是安全的。有必要进行进一步的研究。
