Major recent clinical cardioprotection studies of pharmacological interventions in patients with AMI
| Study | n | Patient criteria | Treatment protocol | Main outcome | Notes |
|---|---|---|---|---|---|
| Cyclosporin-A | |||||
| Piot et al., 2008 | 58 | All STEMI | IV bolus of CsA administered 10 min prior to PPCI | Reduce MI size assessed by AUC CK. No difference in troponin I. Subset of 37 patients reduce MI size on MRI at day 5 post-PPCI | First clinical study to show cardioprotection with CsA |
| Cung et al., 2015; Ottani et al., 2016 CIRCUS | 970 | Anterior STEMI Pre-PPCI TIMI 0/1 | IV bolus of CsA administered prior to PPCI | No difference in primary outcome worsening in-pt heart failure, HHF, or adverse LV remodeling at 1 yr | Largest outcome study with CsA |
| Cung et al., 2015; Ottani et al., 2016 CYCLE | 410 | All STEMI | IV bolus of CsA administered prior to PPCI | No difference in primary endpoint of ≥70% ST-segment resolution 60 min after TIMI flow grade 3 or MI size (day 4 hs-cTnT) or LV remodeling at 6 mo. | |
| MTP-131 | |||||
| Gibson et al., 2016 EMBRACE-STEMI | 118 | Anterior STEMI Pre-PPCI TIMI 0/1 | IV 60-min infusion of MTP-131 started prior to PPCI | No difference in primary endpoint of MI size (72 h AUC CK). No difference in MI size or LV remodeling on MRI at 4 and 30 days | |
| TRO40303 | |||||
| Atar et al., 2015 MITOCARE | 163 | All STEMI within 6 h chest pain Pre-PPCI TIMI 0/1 | IV bolus of TRO40303 administered prior to PPCI | No difference in primary endpoint of MI size (72 h AUC CK or hs-cTnI) | There was a significant increase in major adverse events with the study drug compared with placebo |
| Nitrite | |||||
| Siddiqi et al., 2014 NIAMI | 229 | All STEMI TIMI 0/1 | IV bolus of nitrite administered prior to PPCI | No difference in primary endpoint of MI size on MRI at day 6–8. No difference in LV remodeling or MI size by (72 h AUC CK or cTnI) | |
| Jones, Pellaton, et al., 2015 | 198 | All STEMI | Intracoronary bolus of nitrite administered prior to PPCI | No difference in primary endpoint of MI size (72 h AUC CK or hs-cTnI) | |
| N-acetylcysteine + Nitroglycerin | |||||
| Hausenloy and Yellon, 2017; Pasupathy et al., 2017 NACIAM | 75 | All STEMI | IV infusion of NAC for 48 h initiated prior to PPCI. On background of IV GTN infusion | Reduction (by 33%) in primary endpoint of MI size by CMR at day 2–3 post-PPCI | |
| Inhaled nitric oxide | |||||
| Janssens et al., 2018 NOMI | 250 | All STEMI | Inhaled oxygen with NO started 10 min prior to PPCI and continued for 4 h | No difference in primary endpoint of MI size by MRI at day 2–3 | |
| Tocilizumab (IL-6 receptor antibody) | |||||
| Kleveland et al., 2016 | 117 | NSTEMI | IV 60-min infusion started prior to PPCI | Reduced hsCRP levels. Reduced median AUC for hs-cTnT by 30% | |
| Broch et al., 2021 ASSAIL-MI | 199 | All STEMI | IV 60-min infusion started during PPCI | Increased myocardial salvage by 5.6% on CMR (2–7 days) and less MVO but no difference in MI size | |
AUC, area under curve; CMR: cardiac magnetic resonance; CK-MB, creatine kinase MB isoenzyme; GTN, glyceryl trinitrate; hs-cTnT/I, high-sensitive cardiac troponin T/I; HHF, hospitalization for heart failure; IV, intravenous; LAD, left anterior descending artery; MI, myocardial infarction; MVO, microvascular obstruction; NAC, N-acetylcysteine; NSTEMI, non-ST-segment elevation myocardial infarction; PPCI, primary percutaneous coronary intervention; STEMI, ST-segment elevation myocardial infarction.