Skip to main content
British Heart Journal logoLink to British Heart Journal
. 1981 May;45(5):583–588. doi: 10.1136/hrt.45.5.583

Limitation of myocardial infarct size in patients less than 66 years treated with alprenolol.

J H Jürgensen, J Frederiksen, D A Hansen, O Pedersen-Bjergaard
PMCID: PMC482568  PMID: 7016150

Abstract

Two hundred and eighty-two patients less than 66 years of age admitted with suspected or definite myocardial infarction were allocated in a random fashion to treatment with alprenolol or placebo. Treatment was started immediately upon admission with 5-10 mg alprenolol or placebo intravenously, followed by 200 mg alprenolol or placebo orally twice a day for one year. In 178 patients a definite myocardial infarction was diagnosed. Myocardial infarct size could be estimated from serial determinations of serum total creatine kinase in 42 patients treated with alprenolol and 43 patients receiving placebos. Median infarct size was 20.6 CK g Eq/m2 body surface in the alprenolol group, the corresponding figure in the placebo group being 34.4 CK g Eq/m2 body surface. Median rate of release of creatine kinase from the ischaemic myocardium was 27.7 U/1 per hour and 48.0 U/1 per hour after alprenolol and placebo, respectively. Alprenolol limited infarct size significantly provided the treatment was started within 12 hours of the onset of symptoms.

Full text

PDF
587

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alonso D. R., Scheidt S., Post M., Killip T. Pathophysiology of cardiogenic shock. Quantification of myocardial necrosis, clinical, pathologic and electrocardiographic correlations. Circulation. 1973 Sep;48(3):588–596. doi: 10.1161/01.cir.48.3.588. [DOI] [PubMed] [Google Scholar]
  2. Andersen M. P., Bechsgaard P., Frederiksen J., Hansen D. A., Jürgensen H. J., Nielsen B., Pedersen F., Pedersen-Bjergaard O., Rasmussen S. L. Effect of alprenolol on mortality among patients with definite or suspected acute myocardial infarction. Preliminary results. Lancet. 1979 Oct 27;2(8148):865–868. doi: 10.1016/s0140-6736(79)92684-9. [DOI] [PubMed] [Google Scholar]
  3. Becker L. C., Fortuin N. J., Pitt B. Effect of ischemia and antianginal drugs on the distribution of radioactive microspheres in the canine left ventricle. Circ Res. 1971 Feb;28(2):263–269. doi: 10.1161/01.res.28.2.263. [DOI] [PubMed] [Google Scholar]
  4. Bleifeld W., Mathey D., Hanrath P., Buss H., Effert S. Infarct size estimated from serial serum creatine phosphokinase in relation to left ventricular hemodynamics. Circulation. 1977 Feb;55(2):303–311. doi: 10.1161/01.cir.55.2.303. [DOI] [PubMed] [Google Scholar]
  5. Bloor C. M., Ehsani A., White F. C., Sobel B. E. Ventricular fibrillation threshold in acute myocardial infarction and its relation to myocardial infarct size. Cardiovasc Res. 1975 Jul;9(4):468–472. doi: 10.1093/cvr/9.4.468. [DOI] [PubMed] [Google Scholar]
  6. Braunwald E. Thirteenth Bowditch lecture. The determinants of myocardial oxygen consumption. Physiologist. 1969 May;12(2):65–93. [PubMed] [Google Scholar]
  7. Christensen N. J., Videbaek J. Plasma catecholamines and carbohydrate metabolism in patients with acute myocardial infarction. J Clin Invest. 1974 Aug;54(2):278–286. doi: 10.1172/JCI107763. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Frishman W. H., Christodoulou J., Weksler B., Smithen C., Killip T., Scheidt S. Abrupt propranolol withdrawal in angina pectoris: effects on platelet aggregation and exercise tolerance. Am Heart J. 1978 Feb;95(2):169–179. doi: 10.1016/0002-8703(78)90460-x. [DOI] [PubMed] [Google Scholar]
  9. Geltman E. M., Ehsani A. A., Campbell M. K., Schechtman K., Roberts R., Sobel B. E. The influence of location and extent of myocardial infarction on long-term ventricular dysrhythmia and mortality. Circulation. 1979 Oct;60(4):805–814. doi: 10.1161/01.cir.60.4.805. [DOI] [PubMed] [Google Scholar]
  10. Gold H. K., Leinbach R. C., Maroko P. R. Propranolol-induced reduction of signs of ischemic injury during acute myocardial infarction. Am J Cardiol. 1976 Nov 23;38(6):689–695. doi: 10.1016/0002-9149(76)90344-1. [DOI] [PubMed] [Google Scholar]
  11. Gross G. J., Winbury M. M. Beta adrenergic blockade on intramyocardial distribution of coronary blood flow. J Pharmacol Exp Ther. 1973 Dec;187(3):451–464. [PubMed] [Google Scholar]
  12. Holman B. L., Chisholm R. J., Braunwald E. The prognostic implications of acute myocardial infarct scintigraphy with 99mTc-pyrophosphate. Circulation. 1978 Feb;57(2):320–326. doi: 10.1161/01.cir.57.2.320. [DOI] [PubMed] [Google Scholar]
  13. Inoue M., Hori M., Fukui S., Abe H., Minamino T. Evaluation of evolution of myocardial infarction by serial determinations of serum creatine kinase activity. Br Heart J. 1977 May;39(5):485–492. doi: 10.1136/hrt.39.5.485. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Kjekshus J. K., Sobel B. E. Depressed myocardial creatine phosphokinase activity following experimental myocardial infarction in rabbit. Circ Res. 1970 Sep;27(3):403–414. doi: 10.1161/01.res.27.3.403. [DOI] [PubMed] [Google Scholar]
  15. Kupper W., Bleifeld W., Hanrath P., Effert S. Berechnung der akuten Infarktgrösse aus den Serumkonzentrationen des CK-MB-Isoenzyms. Dtsch Med Wochenschr. 1978 Mar 31;103(13):550–556. doi: 10.1055/s-0028-1104474. [DOI] [PubMed] [Google Scholar]
  16. Lichtman M. A., Cohen J., Murphy M. S., Kearney E. A., Whitbeck A. A. Effect of propranolol on oxygen binding to hemoglobin in vitro and in vivo. Circulation. 1974 May;49(5):881–886. doi: 10.1161/01.cir.49.5.881. [DOI] [PubMed] [Google Scholar]
  17. Maroko P. R., Kjekshus J. K., Sobel B. E., Watanabe T., Covell J. W., Ross J., Jr, Braunwald E. Factors influencing infarct size following experimental coronary artery occlusions. Circulation. 1971 Jan;43(1):67–82. doi: 10.1161/01.cir.43.1.67. [DOI] [PubMed] [Google Scholar]
  18. Maroko P. R., Libby P., Covell J. W., Sobel B. E., Ross J., Jr, Braunwald E. Precordial S-T segment elevation mapping: an atraumatic method for assessing alterations in the extent of myocardial ischemic injury. The effects of pharmacologic and hemodynamic interventions. Am J Cardiol. 1972 Feb;29(2):223–230. doi: 10.1016/0002-9149(72)90633-9. [DOI] [PubMed] [Google Scholar]
  19. Mathey D., Biefield W., Hanrath P., Effert S. Attempt to quantitate relation between cardiac function and infarct size in acute myocardial infarction. Br Heart J. 1974 Mar;36(3):271–279. doi: 10.1136/hrt.36.3.271. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Mathey D., Bleifeld W., Buss H., Hanrath P. Creatine kinase release in acute myocardial infarction: correlation with clinical, electrocardiographic, and pathological findings. Br Heart J. 1975 Nov;37(11):1161–1168. doi: 10.1136/hrt.37.11.1161. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Mehta J., Mehta P., Pepine C. J. Platelet aggregation in aortic and coronary venous blood in patients with and without coronary disease. 3. Role of tachycardia stress and propranolol. Circulation. 1978 Nov;58(5):881–886. doi: 10.1161/01.cir.58.5.881. [DOI] [PubMed] [Google Scholar]
  22. Mueller H. S., Ayres S. M., Religa A., Evans R. G. Propranolol in the treatment of acute myocardial infarction. Effect on myocardial oxygenation and hemodynamics. Circulation. 1974 Jun;49(6):1078–1087. doi: 10.1161/01.cir.49.6.1078. [DOI] [PubMed] [Google Scholar]
  23. Norris R. M., Clarke E. D., Sammel N. L., Smith W. M., Williams B. Protective effect of propranolol in threatened myocardial infarction. Lancet. 1978 Oct 28;2(8096):907–909. doi: 10.1016/s0140-6736(78)91628-8. [DOI] [PubMed] [Google Scholar]
  24. Norris R. M., Whitlock R. M., Barratt-Boyes C., Small C. W. Clinical measurement of myocardial infarct size. Modification of a method for the estimation of total creatine phosphokinase release after myocardial infarction. Circulation. 1975 Apr;51(4):614–620. doi: 10.1161/01.cir.51.4.614. [DOI] [PubMed] [Google Scholar]
  25. Oski F. A., Miller L. D., Delivoria-Papadopoulos M., Manchester J. H., Shelburn J. C. Oxygen affinity in red cells: changes induced in vivo by propranolol. Science. 1972 Mar 24;175(4028):1372–1373. doi: 10.1126/science.175.4028.1372. [DOI] [PubMed] [Google Scholar]
  26. Pelides L. J., Reid D. S., Thomas M., Shillingford J. P. Inhibition by -blockade of the ST segment elevation after acute myocardial infarction in man. Cardiovasc Res. 1972 May;6(3):295–301. doi: 10.1093/cvr/6.3.295. [DOI] [PubMed] [Google Scholar]
  27. Pendleton R. G., Newman D. J., Sherman S. S., Brann E. G., Maya W. E. Effect of propranolol upon the hemoglobin-oxygen dissociation curve. J Pharmacol Exp Ther. 1972 Mar;180(3):647–656. [PubMed] [Google Scholar]
  28. Peter T., Norris R. M., Clarke E. D., Heng M. K., Singh B. N., Williams B., Howell D. R., Ambler P. K. Reduction of enzyme levels by propranolol after acute myocardial infarction. Circulation. 1978 Jun;57(6):1091–1095. doi: 10.1161/01.cir.57.6.1091. [DOI] [PubMed] [Google Scholar]
  29. Roberts R., Henry P. D., Sobel B. E. An improved basis for enzymatic estimation of infarct size. Circulation. 1975 Nov;52(5):743–754. doi: 10.1161/01.cir.52.5.743. [DOI] [PubMed] [Google Scholar]
  30. Roberts R., Husain A., Ambos H. D., Oliver G. C., Cox J. R., Jr, Sobel B. E. Relation between infarct size and ventricular arrhythmia. Br Heart J. 1975 Nov;37(11):1169–1175. doi: 10.1136/hrt.37.11.1169. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Roe C. R., Cobb F. R., Starmer C. F. The relationship between enzymatic and histologic estimates of the extent of myocardial infarction in conscious dogs with permanent coronary occlusion. Circulation. 1977 Mar;55(3):438–449. doi: 10.1161/01.cir.55.3.438. [DOI] [PubMed] [Google Scholar]
  32. Rogers W. J., McDaniel H. G., Smith L. R., Mantle J. A., Russel R. O., Jr, Rackley C. E. Correlation of angiographic estimates of myocardial infarct size and accumulated release of creatine kinase MB isoenzyme in man. Circulation. 1977 Aug;56(2):199–205. doi: 10.1161/01.cir.56.2.199. [DOI] [PubMed] [Google Scholar]
  33. Rosalki S. B. An improved procedure for serum creatine phosphokinase determination. J Lab Clin Med. 1967 Apr;69(4):696–705. [PubMed] [Google Scholar]
  34. Schrumpf J. D., Sheps D. S., Wolfson S., Aronson A. L., Cohen L. S. Altered hemoglobin-oxygen affinity with long-term propranolol therapy in patients with coronary artery disease. Am J Cardiol. 1977 Jul;40(1):76–82. doi: 10.1016/0002-9149(77)90104-7. [DOI] [PubMed] [Google Scholar]
  35. Shell W. E., Kjekshus J. K., Sobel B. E. Quantitative assessment of the extent of myocardial infarction in the conscious dog by means of analysis of serial changes in serum creatine phosphokinase activity. J Clin Invest. 1971 Dec;50(12):2614–2625. doi: 10.1172/JCI106762. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Shell W. E., Lavelle J. F., Covell J. W., Sobel B. E. Early estimation of myocardial damage in conscious dogs and patients with evolving acute myocardial infarction. J Clin Invest. 1973 Oct;52(10):2579–2590. doi: 10.1172/JCI107450. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Sobel B. E., Bresnahan G. F., Shell W. E., Yoder R. D. Estimation of infarct size in man and its relation to prognosis. Circulation. 1972 Oct;46(4):640–648. doi: 10.1161/01.cir.46.4.640. [DOI] [PubMed] [Google Scholar]
  38. Sobel B. E., Weiss E. S., Welch M. J., Siegel B. A., Ter-Pogossian M. M. Detection of remote myocardial infarction in patients with positron emission transaxial tomography and intravenous 11C-palmitate. Circulation. 1977 Jun;55(6):853–857. doi: 10.1161/01.cir.55.6.853. [DOI] [PubMed] [Google Scholar]
  39. Stein P. D., Brooks H. L., Matson J. L., Hyland J. W. Effect of beta-adrenergic blockade on coronary blood flow. Cardiovasc Res. 1968 Jan;2(1):63–76. doi: 10.1093/cvr/2.1.63. [DOI] [PubMed] [Google Scholar]
  40. Waldenström A. P., Hjalmarson A. C., Thornell L. A possible role of noradrenaline in the development of myocardial infarction: an experimental study in the isolated rat heart. Am Heart J. 1978 Jan;95(1):43–51. doi: 10.1016/0002-8703(78)90395-2. [DOI] [PubMed] [Google Scholar]
  41. Wickline S. A., McNamara J. J. Vectorcardiographic quantification of infarct size in baboons. Circulation. 1978 May;57(5):910–920. doi: 10.1161/01.cir.57.5.910. [DOI] [PubMed] [Google Scholar]
  42. Wilhelmsson C., Vedin J. A., Wilhelmsen L., Tibblin G., Werkö L. Reduction of sudden deaths after myocardial infarction by treatment with alprenolol. Preliminary results. Lancet. 1974 Nov 16;2(7890):1157–1160. doi: 10.1016/s0140-6736(74)90807-1. [DOI] [PubMed] [Google Scholar]
  43. Wirtzfeld A., Klein G., Delius W., Sack D. Behandlung des akuten Myokardinfarktes mit Metoprolol. Dtsch Med Wochenschr. 1978 Mar 31;103(13):566–574. doi: 10.1055/s-0028-1104477. [DOI] [PubMed] [Google Scholar]
  44. Yusuf S., Ramsdale D., Peto R., Furse L., Bennett D., Bray C., Sleight P. Early intravenous atenolol treatment in suspected acute myocardial infarction. Preliminary report of a randomised trial. Lancet. 1980 Aug 9;2(8189):273–276. doi: 10.1016/s0140-6736(80)90231-7. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES