Mineralocorticoid receptor antagonist pre-treatment and early post-treatment to minimize reperfusion injury after ST-elevation myocardial infarction: The MINIMIZE STEMI trial.
Aged
Canrenoic Acid
/ therapeutic use
Cardiac Imaging Techniques
Double-Blind Method
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Mineralocorticoid Receptor Antagonists
/ therapeutic use
Myocardial Reperfusion Injury
/ prevention & control
Percutaneous Coronary Intervention
Pilot Projects
Proof of Concept Study
ST Elevation Myocardial Infarction
/ diagnostic imaging
Spironolactone
/ therapeutic use
Ventricular Remodeling
/ drug effects
Journal
American heart journal
ISSN: 1097-6744
Titre abrégé: Am Heart J
Pays: United States
ID NLM: 0370465
Informations de publication
Date de publication:
05 2019
05 2019
Historique:
received:
20
05
2018
accepted:
11
02
2019
pubmed:
21
3
2019
medline:
13
2
2020
entrez:
21
3
2019
Statut:
ppublish
Résumé
Mineralocorticoid receptor antagonist (MRA) therapy has been shown to prevent adverse left ventricular (LV) remodeling in ST-segment elevation myocardial infarction (STEMI) patients with heart failure. Whether initiating MRA therapy prior to primary percutaneous coronary intervention (PPCI) accrues additional benefit of reducing myocardial infarct size and preventing adverse LV remodeling is not known. We aimed to investigate whether MRA therapy initiated prior to reperfusion reduces myocardial infarct (MI) size and prevents adverse LV remodeling in STEMI patients. STEMI patients presenting within 12 hours and with a proximal coronary artery occlusion with Thrombolysis In Myocardial Infarction flow grade 0 were consented and randomized to either an intravenous bolus of potassium canrenoate, followed by oral spironolactone for 3 months or matching placebo. The primary endpoint was MI size by cardiovascular magnetic resonance at 3 months. Sixty-seven patients completed the study. There was no significant difference in the final MI size at 3 months between the 2 groups (placebo: 17 ± 11%, MRA: 16 ± 10%, P = .574). There was also no difference in acute MI size (26 ± 16% versus 23 ± 14%, P = .425) or myocardial salvage (26 ± 12% versus 24 ± 8%, P = .456). At follow-up, there was a trend towards an improvement in LVEF (placebo: 49 ± 8%, MRA: 54 ± 11%, P = .053), and the MRA group had significantly greater percentage decrease in LVEDV (mean difference: -12.2 (95% CI -20.3 to -4.4)%, P = .003) and LVESV (mean difference: -18.2 (95% CI -30.1 to -6.3)%, P = .003). This pilot study showed no benefit of MRA therapy in reducing MI size in STEMI patients when initiated prior to reperfusion, but there was an improvement in LV remodeling at 3 months. Adequately powered studies are warranted to confirm these findings.
Sections du résumé
BACKGROUND
Mineralocorticoid receptor antagonist (MRA) therapy has been shown to prevent adverse left ventricular (LV) remodeling in ST-segment elevation myocardial infarction (STEMI) patients with heart failure. Whether initiating MRA therapy prior to primary percutaneous coronary intervention (PPCI) accrues additional benefit of reducing myocardial infarct size and preventing adverse LV remodeling is not known. We aimed to investigate whether MRA therapy initiated prior to reperfusion reduces myocardial infarct (MI) size and prevents adverse LV remodeling in STEMI patients.
METHODS
STEMI patients presenting within 12 hours and with a proximal coronary artery occlusion with Thrombolysis In Myocardial Infarction flow grade 0 were consented and randomized to either an intravenous bolus of potassium canrenoate, followed by oral spironolactone for 3 months or matching placebo. The primary endpoint was MI size by cardiovascular magnetic resonance at 3 months.
RESULTS
Sixty-seven patients completed the study. There was no significant difference in the final MI size at 3 months between the 2 groups (placebo: 17 ± 11%, MRA: 16 ± 10%, P = .574). There was also no difference in acute MI size (26 ± 16% versus 23 ± 14%, P = .425) or myocardial salvage (26 ± 12% versus 24 ± 8%, P = .456). At follow-up, there was a trend towards an improvement in LVEF (placebo: 49 ± 8%, MRA: 54 ± 11%, P = .053), and the MRA group had significantly greater percentage decrease in LVEDV (mean difference: -12.2 (95% CI -20.3 to -4.4)%, P = .003) and LVESV (mean difference: -18.2 (95% CI -30.1 to -6.3)%, P = .003).
CONCLUSION
This pilot study showed no benefit of MRA therapy in reducing MI size in STEMI patients when initiated prior to reperfusion, but there was an improvement in LV remodeling at 3 months. Adequately powered studies are warranted to confirm these findings.
Identifiants
pubmed: 30893577
pii: S0002-8703(19)30026-2
doi: 10.1016/j.ahj.2019.02.005
pmc: PMC6483973
pii:
doi:
Substances chimiques
Mineralocorticoid Receptor Antagonists
0
Spironolactone
27O7W4T232
Canrenoic Acid
87UG89VA9K
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
60-67Subventions
Organisme : British Heart Foundation
ID : FS/10/40/28260
Pays : United Kingdom
Organisme : British Heart Foundation
ID : FS/12/56/29723
Pays : United Kingdom
Organisme : British Heart Foundation
ID : CS/14/3/31002
Pays : United Kingdom
Informations de copyright
Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.
Références
N Engl J Med. 2012 Jan 5;366(1):54-63
pubmed: 22216842
Eur Heart J. 2018 Jan 7;39(2):119-177
pubmed: 28886621
Radiology. 2011 Jun;259(3):704-11
pubmed: 21467254
JACC Cardiovasc Imaging. 2017 Mar;10(3):230-240
pubmed: 28279370
Am Heart J. 2009 Jun;157(6):1088-96
pubmed: 19464421
Am Heart J. 2010 Oct;160(4):642-8
pubmed: 20934557
Eur Heart J. 2014 Sep 7;35(34):2295-302
pubmed: 24780614
Circ Heart Fail. 2013 Mar;6(2):156-65
pubmed: 23400891
J Am Coll Cardiol. 2016 Apr 26;67(16):1917-27
pubmed: 27102506
Circ Cardiovasc Interv. 2017 Mar;10(3):
pubmed: 28242607
Am Heart J. 2018 Jan;195:60-69
pubmed: 29224647
Sci Rep. 2017 Jul 7;7(1):4871
pubmed: 28687810
Heart. 2016 Mar;102(5):341-8
pubmed: 26674987
Circulation. 2013 Oct 15;128(16):1810-52
pubmed: 23741057
JAMA Intern Med. 2018 Jul 1;178(7):913-920
pubmed: 29799995
Int J Cardiol. 2016 Aug 1;216:110-3
pubmed: 27149239
N Engl J Med. 2003 Apr 3;348(14):1309-21
pubmed: 12668699
Open Heart. 2016 Dec 12;3(2):e000535
pubmed: 28008358
Heart. 2018 Nov;104(22):1843-1849
pubmed: 29695512
J Am Coll Cardiol. 2009 Jan 6;53(1):13-20
pubmed: 19118718
Eur Heart J. 2013 Jun;34(23):1714-22
pubmed: 23536610
Circulation. 2000 Nov 28;102(22):2700-6
pubmed: 11094035
Clin Cardiol. 2015 May;38(5):259-66
pubmed: 25990305
J Cardiovasc Magn Reson. 2017 Mar 13;19(1):26
pubmed: 28285594
J Mol Cell Cardiol. 1994 Jul;26(7):809-20
pubmed: 7966349
Eur Heart J. 2010 Jul;31(13):1655-62
pubmed: 20028693