Acute hemodynamic effects of landiolol, an ultra-short-acting beta-blocker, in patients with acute coronary syndrome: preliminary study.

Objectives: We aimed to evaluate acute hemodynamic effects and safety of landiolol in patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI).

Background: Beta-blockers have been proven to be effective for the treatment of ischemic heart disease in both the acute and chronic phases. Landiolol, an ultra-short-acting and highly cardioselective beta-1 blocker, has become available in Japan. In the clinical setting, the hemodynamic response to landiolol administration remains unclear in patients presenting with ACS.

Methods: From August 2007 to April 2008, landiolol was administered intravenously immediately before reperfusion procedure in 22 consecutive ACS patients (mean age, 63±9 years; 15 men) with a heart rate (HR) of ≥70 beats/min. The initial intravenous administration dose of landiolol was 20 μg/kg/min in all patients. The maintenance dose was titrated with the aim of reducing HR by 15%. Acute hemodynamic data including HR and systolic and diastolic blood pressure were serially evaluated.

Results: HR dropped significantly (from 87±11 to 72±8beats/min, p<0.001) 20 min after landiolol initiation. However, systolic and diastolic pressure remained unchanged during administration of landiolol. Although landiolol was discontinued in 2 patients because of sinus bradycardia, no serious complications such as advanced degree atrioventricular block, requiring temporary cardiac pacing, severe hypotension, cardiogenic shock, or deterioration of heart failure were observed in the patients receiving landiolol.

Conclusions: Landiolol was safe and effective in reducing oxygen demand of the ischemic heart by reducing only HR without lowering blood pressure in patients with ACS undergoing PCI.