RESCUE THERAPY WITH C1-ESTERASE INHIBITOR CONCENTRATE AFTER EMERGENCYCORONARY SURGERY FOR FAILED PTCA

Administration of C1-esterase inhibitor (C1-INH) attenuates myocardial necrosis and sustains normal cardiac performance after myocardial isc hemia and reperfusion in animal experiments. We report on our first ex perience of C1-INH application as rescue therapy in patients undergoin g emergency surgical revascularization after failed percutaneous trans luminal coronary angioplasty. Three patients were treated, because pos t operative hemodynamic stabilization could not be achieved despite pr olonged reperfusion periods, high-dose inotropic support, inodilators and aortic counterpulsation. As there was no surgical or medical optio n remaining, C1-INH was administered starting with a 2000 unit bolus, followed by 1000 U 12 and 24 h after surgery. C1-INH therapy resulted in rapid hemodynamic sta bilization of all patients; weaning from aort ic counterpulsation and epinephrine support was possible within 1 day. All patients survived and were discharged from hospital. In this grou p of patients suffering from severe reperfusion injury after coronary surgery, C1-INH seemed to be an effective adjuvant therapy to restore myocardial function by blocking the complement cascade. These results should encourage the performance of controlled studies on the effects of prophylactic C1-INH substitution therapy in patients undergoing cor onary surgery at high risk conditions.