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Intracoronary EnalaPrilat to Reduce MICROvascular Damage During Percutaneous Coronary Intervention (ProMicro) study

Fabio Mangiacapra1, Aaron J Peace, Luigi Di Serafino

  • 1Cardiovascular Center Aalst OLV Clinic, Aalst, Belgium.

Journal of the American College of Cardiology
|January 8, 2013
PubMed

Insights

Intracoronary enalaprilat improved coronary microvascular function and reduced myocardial injury during percutaneous coronary intervention (PCI) in stable angina patients. This suggests enalaprilat may offer protection against procedure-related damage.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Biology

Background:

  • Intracoronary angiotensin-converting enzyme inhibitors can alleviate myocardial ischemia and improve epicardial flow.
  • The role of coronary microcirculation modulation in these effects remains unclear.

Purpose of the Study:

  • To investigate the impact of intracoronary enalaprilat on coronary microvascular function.
  • To assess peri-procedural outcomes in patients with stable angina undergoing percutaneous coronary intervention (PCI).

Main Methods:

  • 40 patients were randomized to receive either intracoronary enalaprilat (50 μg) or placebo before elective PCI.
  • Index of microvascular resistance (IMR) and high-sensitivity cardiac troponin T (hs-cTnT) were measured.
  • IMR was assessed at baseline, 10 minutes post-drug, and post-PCI.

Main Results:

  • Enalaprilat significantly reduced IMR post-PCI compared to placebo (p < 0.001).
  • The enalaprilat group showed significantly lower peak hs-cTnT levels (p = 0.048) and peri-procedural hs-cTnT increases (p = 0.025).
  • Placebo group exhibited a significant post-procedural increase in IMR.

Conclusions:

  • Intracoronary enalaprilat enhances coronary microvascular function.
  • Enalaprilat protects the myocardium from periprocedural injury in patients undergoing PCI.
  • Larger studies are needed to confirm clinical benefits.
Abstract

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