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Original research article
Role of endothelin in microvascular dysfunction following percutaneous coronary intervention for non-ST elevation acute coronary syndromes: a single-centre randomised controlled trial
  1. Raviteja R Guddeti1,2,
  2. Abhiram Prasad1,
  3. Yasushi Matsuzawa1,
  4. Tatsuo Aoki1,
  5. Charanjit Rihal1,
  6. David Holmes1,
  7. Patricia Best1,
  8. Ryan J Lennon3,
  9. Lilach O Lerman4 and
  10. Amir Lerman1
  1. 1Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, Minnesota, USA
  2. 2Division of Internal Medicine, Marshfield Clinic, Marshfield, Wisconsin, USA
  3. 3Division of Biomedical Statistics and Informatics, Mayo College of Medicine, Rochester, Minnesota, USA
  4. 4Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Abhiram Prasad; prasad.abhiram{at}


Objectives Percutaneous coronary intervention (PCI) for acute coronary syndromes frequently fails to restore myocardial perfusion despite establishing epicardial vessel patency. Endothelin-1 (ET-1) is a potent vasoconstrictor, and its expression is increased in atherosclerosis and after PCI. In this study, we aim to define the role of endothelin in regulating coronary microvascular blood flow and myocardial perfusion following PCI in patients with non-ST elevation acute coronary syndromes (NSTACS), by assessing whether adjunctive therapy with a selective endothelin A (ETA) receptor antagonist acutely improves postprocedural coronary microvascular blood flow.

Methods In a randomised, double-blinded, placebo-controlled trial, 23 NSTACS patients were enrolled to receive an intracoronary infusion of placebo (n=11) or BQ-123 (n=12) immediately before PCI. Post-PCI coronary microvascular blood flow and myocardial perfusion were assessed by measuring Doppler-derived average peak velocity (APV), and cardiac biomarker levels were quantified.

Results Compared with the placebo group, APV was significantly higher in the drug group immediately after PCI (30 (20, 37) vs 19 (9, 26) cm/s; p=0.03). Hyperaemic APV, measured post-adenosine administration, was higher in the BQ-123 group, but the difference did not achieve statistical significance (56 (48, 72) vs 46 (34, 64) cm/s; p=0.090). Maximum coronary flow reserve postprocedure was not different between the two groups (2.1 (1.6, 2.3) vs 2.5 (1.8, 3.0)). Per cent change in creatine kinase isoenzyme MB from the time of PCI to 8 and 16 hours post-PCI was significantly lower in the drug group compared with the placebo group (−17 (−26, −10) vs 26 (−15, 134); p=0.02 and −17 (−38, 14) vs 107 (2, 446); p=0.007, respectively).

Conclusions Endothelin is a mediator of microvascular dysfunction during PCI in NSTACS, and adjunctive selective ETA antagonist may augment myocardial perfusion during PCI.

Trial registration number NCT00586820; Results.

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