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(Circulation. 2000;102:1937.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Acute Endothelin-A Receptor Antagonism Prevents Normal Reduction of Myocardial Ischemia on Repeated Balloon Inflations During Angioplasty

Zenon S. Kyriakides, MD; Dimitrios Th. Kremastinos, MD; Theofilos M. Kolettis, MD; Androniki Tasouli, MD; Aias Antoniadis, MD; David J. Webb, MD

From the Second Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece (Z.S.K., D.T.K., T.M.K., A.T., A.A.), and the Department of Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK (D.J.W.).

Correspondence to Zenon S. Kyriakides, MD, Onassis Cardiac Surgery Center, 356 Sygrou Ave, GR-17674 Athens, Greece. E-mail zskyr{at}otenet.gr

Background—Myocardial ischemia and reperfusion are associated with increased production of endothelin (ET)-1.

Methods and Results—We examined the effects of BQ-123, a selective ET_A receptor antagonist, in 80 patients. All patients were randomly allocated to an intracoronary infusion of saline or BQ-123 (6 µmol/L over 20 minutes). The reference group consisted of 20 patients undergoing coronary angiography. BQ-123 produced a 10% (P<0.005) increase in distal coronary artery diameter. The main study group consisted of 30 patients undergoing coronary angioplasty. All patients underwent a minimum of 3 balloon inflations (BIs). Surface and intracoronary electrocardiographic ST-segment shift as well as pain score were recorded at the end of each BI. BQ-123 or saline was given by intracoronary infusion between the second and the third BI in random allocation. In the saline group, intracoronary ST-elevation decreased from 1.26±0.55 mV during the first BI to 0.77±0.56 mV during the third BI (P<0.05) and the surface ST elevation decreased from 0.20±0.15 to 0.10±0.07 mV (P<0.05). In the BQ-123 group, the respective values were 1.22±0.48 mV and 1.13±0.62 mV (intracoronary) and 0.17±0.18 and 0.17±0.21 mV (surface) (both P=NS). The decrease in pain score was significantly higher in the saline group (F=5.97, P=0.004). In 30 patients (collateral circulation group), the angioplasty protocol was repeated with the use of a pressure guide wire. BQ-123 produced a significant (F=3.30, P=0.04) decrease in coronary wedge pressure.

Conclusions—Acute ET_A receptor antagonism prevents the normal reduction of myocardial ischemia on repeated BIs during angioplasty. This may be explained by a "steal" effect through coronary collaterals.

Key Words: endothelin • ischemia • angioplasty

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