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CLINICAL RESEARCH: CORONARY HEART DISEASE

Ethanol Abolishes Ischemic Preconditioning in Humans

Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.

Manuscript received July 17, 2007; revised manuscript received August 30, 2007, accepted September 7, 2007.

^_* Reprint requests and correspondence: Dr. Giampaolo Niccoli, Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, 00168 Rome, Italy. (Email: gniccoli73{at}hotmail.it).

Objectives: This study sought to assess the effect of acute alcohol intake on ischemic preconditioning (IPC) in humans using the clinical model of 2 sequential balloon inflations during a percutaneous coronary intervention (PCI).

Background: Ischemic preconditioning is the most potent form of endogenous myocardial protection from irreversible ischemic injury. Experimental observations suggest that acute ethanol administration might abolish IPC.

Methods: We studied 30 consecutive patients (22 men, mean age 65 years) undergoing elective coronary angioplasty who were randomized to receive an oral dose of 40 g ethylic alcohol (administered as 149 ml of Gordon’s Gin) or 149 ml of water 30 min before PCI. Intracoronary electrocardiogram was continuously monitored to assess the greatest ST-segment elevation or depression from baseline.

Results: In placebo-treated patients, the change of ST-segment shift during the second inflation was significantly smaller than that during the first inflation (19.3 ± 9.1 vs. 15.7 ± 8.7, p = 0.005). In contrast, in gin-treated patients, the change of ST-segment shift during the second inflation was significantly greater than that during the first inflation (18.7 ± 7.2 vs. 22 ± 10, p = 0.03). The group–inflation interaction for ST-segment changes was highly significant (p < 0.001).

Conclusions: This randomized, prospective study in humans shows that administration of a moderate dose of ethanol abolishes IPC occurring during sequential episodes of myocardial ischemia and is associated with worsening ischemia. Based on our study, intake of moderate to high doses of alcoholic beverages should be avoided in patients at high risk of acute myocardial infarction.

Abbreviations and Acronyms   ECG = electrocardiogram   IC = intracoronary   IPC = ischemic preconditioning   PCI = percutaneous coronary intervention

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