Original title: Intracoronary Enalaprilat to Reduce Microvascular Damage During Percutaneous Coronary Intervention (ProMicro) Study. Reference: Fabio Mangiacapra et al. J Am Coll Cardiol 2013. Article in press

Angiotensin converting enzyme (ACE) inhibitors improve clinical outcomes in patients with coronary artery disease and improve epicardial flow in patients with acute ST-segment elevation. 

Beyond the long-term protective effect of oral treatment, intracoronary administration of ACE inhibitors may be beneficial in patients undergoing coronary angioplasty (ATC). This study investigated whether enalaprilat improves micro-vascular function in patients with chronic stable coronary artery disease undergoing scheduled ATC. 

For this, a micro-vascular resistance index (MRI) measurement was performed, coronary flow reserve (CFR) and coronary flow fractional reserve (FFR) with a pressure and temperature guide, (PressureWire Certus, RADI, St. Jude Medical , Uppsala, Sweden), at baseline conditions after administration of the medication and at the end of the ATC. The study included 40 patients with a 1:1 randomization to receive either enalaprilat or a placebo. After the drug was administered a significant reduction in MRI and FFR was observed along with a significant increase in the group CFR enalaprilat. None of these indices was modified in the placebo group. 

After ATC there were no differences in the FFR between the two groups but a significant reduction in MRI as well as a significant increase in CFR for patients receiving enalaprilat versus those in the placebo group. The troponin increase over periprocedural was significantly lower in the enalaprilat group and a relationship was observed between periprocedural myocardial infarction and MRI.

Conclusion 

This study showed for the first time that intracoronary enalaprilat can improve coronary micro-vascular function and protect periprocedural myocardial injury in patients with stable coronary artery disease undergoing angioplasty.

Editorial Comment:

There is a need for larger studies and long-term monitoring to investigate whether these protective effects of enalaprilat may be translated into clinical benefits and justify its standard use. 

Courtesy of Dr. Francisco Ortega.
Fellowship Cardiología Intervencionista.
Fundación Favaloro – Argentina.

Dr. Francisco Ortega para SOLACI.ORG