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.
- 1.Braunwald E, Antman EM, Beasley JW, et al. American College of Cardiology/American Heart Association Committee on the Management of Patients with Unstable Angina. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-elevation myocardial infarction. Summary article: a report of the ACC/AHA task force on practice guidelines (Committee on the Management of Patients with Unstable Angina). J Am Coll Cardiol 2002 Oct 2; 40: 1366–74PubMedCrossRefGoogle Scholar
- 4.Nieminen MS, Bohm M, Cowie MR, et al. ESC Committee for Practice Guideline. Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology. Eur Heart J 2005; 26: 384–416PubMedCrossRefGoogle Scholar
- 12.GISSI-3. Effects of lisinopril and transdermal glyceryl trinitrate singly and together on 6-week mortality and ventricular function after acute myocardial infarction: Gruppo Italiano per lo Studio della Sopravvivenza nell’infarto miocardico. Lancet 1994; 343: 1115–22Google Scholar
- 14.Grossman W. Blood flow measurement: the cardiac output. In: Grossman W, Baim DS, editors. Cardiac catheterization, angiography and intervention. 4th ed. Philadelphia (PA): Lea & Febiger, 1991: 105–22Google Scholar
- 16.Randomised trial of intravenous atenolol among 16 027 cases of suspected acute myocardial infarction: ISIS-1. First International Study of Infarct Survival Collaborative Group. Lancet 1986; 2(8498): 57–66Google Scholar
- 17.Metoprolol in acute myocardial infarction: patient population. The MIAMI Trial Research Group. Am J Cardiol 1985; 56(14): 10G–14GGoogle Scholar
- 18.Hunt SA, Baker DW, Chin MH, et al. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure). Circulation 2001; 104: 2996–3007PubMedCrossRefGoogle Scholar