SYSTEMIC AND CARDIAC CATECHOLAMINES DURING ELECTIVE PTCA AND DURING IMMEDIATE PTCA FOR ACUTE MYOCARDIAL-INFARCTION

This study investigated arterial and coronary venous catecholamine con centrations in patients undergoing either elective coronary angioplast y (PTCA) or direct PTCA for acute myocardial infarction. We included 1 7 patients with stenoses of the left anterior descending coronary arte ry (LAD) and 10 patients with acute anterior myocardial infarction (AM I) undergoing PTCA. During the initial balloon dilatation arterial and coronary venous plasma concentrations of norepinephrine and epinephri ne were determined. In elective PTCA, coronary occlusion (2 min) resul ted in a transient increase of arterial concentrations of norepinephri ne (2.04 +/- 0.30 vs. 1.26 +/- 0.13 nmol/L before dilatation) and epin ephrine (0.52 +/- 0.08 vs. 0.34 +/- 0.04 nmol/L) in the first minute o f reperfusion, whereas coronary venous concentrations of catecholamine s were not changed after dilatation. Among the 10 patients with AMI, i mmediate reperfusion of the LAD (TIMI grade 3) was achieved in 6 patie nts. In these patients, baseline arterial concentrations for norepinep hrine (3.91 +/- 1.16 nmol/L) and epinephrine (4.68 +/- 2.07 nmol/L) we re elevated and no transcardiac gradient for catecholamines was found. In the first minute after successful reopening of the LAD we detected a distinct rise of the transcardiac norepinephrine gradient from -0.1 0 +/- 0.53 to 85.02 +/- 24.64 nmol/L, which declined in the fifth minu te of reperfusion to 4.36 +/- 2.30 nmol/L. Conversely, venous epinephr ine and arterial concentrations for both catecholamines remained uncha nged within the observation period. In the four patients with incomple te (TIMI 0-2) reopening of the LAD, we found no cardiac washout of nor epinephrine. In summary, a transient rise of systemic catecholamines, but no cardiac release of norepinephrine was observed in patients afte r brief coronary occlusion. Conversely, a massive washout of norepinep hrine from the infarcted myocardium occurred during AMI.