P3813Beneficial effect of landiolol on adiponectin and high-molecular weight adiponectin level in patients with stable coronary artery disease performed percutaneous coronary intervention

Abstract

Introduction: Adiponectin (APN) has atheroprotective property and highmolecular weight (HMW) APN is reported as the active form of APN. Animal study has been shown that bisoprolol, of which cardio-selectivity is high (&bgr;1/&bgr;2=120), increases APN expression and reduces myocardial damage. Landiolol is the beta-1 selective receptor blocker developed in Japan and is characterized by a higher cardio-selectivity (&bgr;1/&bgr;2 = 225) and shorter half-life (4 min). Hypothesis: We assessed the hypothesis that using landiolol starting before percutaneouse coronary intervention (PCI) increases serum APN and HMW-APN level in patients with stable angina pectoris (SAP). Methods: We conducted a prospective, randomized, controlled trial for 70 consecutive patients with SAP of using landiolol during the PCI. 35 patients were assigned landiolol group and was started landiolol intravenously just before the PCI with 3 &mgr;g/kg/min and then stopped next day morning. 35 patients were assigned control group. Primary endpoint was changes of serum APN and HMW-APN level from day 0 (the blood sample of the day 0 was obtained three hours before the PCI procedure) within three days after PCI. Results: All PCI procedures were successfully finished. The average serum APN and HMW-APN level of the patients was 9.87/3.89 for day0, 9.32/3.69 for day1, 9.69/3.85 for day2, 9.56/3.82&mgr;g/mL for day 3, respectively. The decrease of serum APN and HMW-APN level from day0 to day1 for the patients was significant (-0.55±0.92&mgr;g/mL, p<0.001 and -0.20±0.45&mgr;g/mL, p<0.001, respectively). Baseline characteristics between landiolol group (n=35) and control group (n=35) including age, sex, coronary risk factors, culprit lesion and medications did not differ (all NS). The decrease of serum APN level from day0 to day1 tended to be smaller (landiolol:-0.38±0.58 vs. control: -0.71±1.16&mgr;g/mL, p=0.14) and those of serum HMW-APN was significantly smaller (landiolol: -0.08±0.27 vs. control:- 0.31±0.55&mgr;g/mL, p=0.031) in patients with landiolol group. The incidence of adverse events such as periprocedural myocardial infarction, hypotension and progression to heart failure with Killip class grade III or IV also did not differ between the two groups (all NS). Median 24-h urinary noradrenaline excretion measured on the day1 did not differ between the two groups (landiolol group: 120 [interquartile range (IQR): 97.5-184] vs. control group: 144 [IQR: 87.1-167] &mgr;g/day, p=0.98). Conclusion: This is the first report that, in patients with SAP performed PCI, serum APN and HMW-APN level immediately decreased after the procedure and landiolol may attenuate the decreasing of serum HMW-APN for those patients.