Intravenous Esmolol is Well Tolerated in Elderly Patients with Heart Failure in the Early Phase of Non-ST Elevation Myocardial Infarction
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To investigate the haemodynamic response to and clinical safety and tolerability of intravenous esmolol (Brevibloc®, Baxter Healthcare Corporation, Deerfield, Illinois, USA) in elderly and younger patients with acute non-ST elevation myocardial infarction (NSTEMI) and heart failure.
Patients and methods
We studied 24 consecutive patients, 12 of them elderly (≥75 years old) and 12 younger (32–74 years old), with NSTEMI and symptoms of heart failure on presentation. After stabilisation of the patient’s condition with standard therapy, intravenous esmolol was administered. An infusion rate of 0.05 mg/kg/min for 30 minutes was instituted and, if no adverse effects developed, this was increased to 0.20 mg/kg/min. All haemodynamic parameters were measured before and at the end of each administration using a Swan-Ganz catheter.
Only one patient in the elderly subgroup did not tolerate the augmented infusion rate (because of severe bradycardia) and so had to return to the initial lower infusion rate. The cardiac index (mean ± SD) was 2.4 ± 0.9 L/min/m2 at baseline and decreased to 1.9 ± 0.4 L/min/m2 (p < 0.05 vs baseline) at the end of the administration of the second dose of esmolol in the elderly patients and 2.6 ± 0.5 L/min/m2 and 2.2 ± 0.5 L/min/m2 (p < 0.05 vs baseline), respectively, in the younger patients. Mean pulmonary wedge pressure was 17 ± 6mm Hg at baseline and increased to 19 ± 4mm Hg (p < 0.05 vs baseline) at the end of the second dose of esmolol in the elderly patients and 16 ± 10mm Hg and 18 ± 10mm Hg (p < 0.05 vs baseline), respectively, in the younger patients. The response of both age groups to esmolol was the same for all of the parameters examined.
Intravenous esmolol was safe and well tolerated in the early phase of NSTEMI in patients presenting with symptoms of heart failure and ongoing ischaemia, regardless of their age.
KeywordsAcute Myocardial Infarction Esmolol Decompensated Heart Failure Muscle Sympathetic Nerve Activity Pulmonary Wedge Pressure
No sources of funding were used to assist in the preparation of this article. The authors have no conflicts of interest that are directly relevant to the content of this study.
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