Abstract 15211: Effect of Cyclosporine a on Infarct Size Reduction in Reperfused Acute Myocardial Infarction Treated with Primary Angioplasty
Introduction: Cyclosporine A (CsA) administered as i.v. bolus before primary angioplasty (PPCI) was reported to significantly reduce infarct size (IS) in 58 STEMI pts.
Hypothesis: CsA may reduce IS in a larger, randomized, multicenter study.
Methods: All patients presenting at one of the 31 participating CCUs with a large STEMI within 6 hours of symptom onset (ST↑ in ≥ 3 leads in anterior MI or ST↑and/or↓ in ≥ 4 leads in non-anterior MI location) with a TIMI-flow 0/1 in the culprit artery, and committed to PPCI, were randomly assigned to CsA (2.5 mg/Kg i.v.) or no-CsA, before PPCI. The primary end-point was a >=70% ST resolution 60 min after TIMI-flow 3. Secondary end-points included centrally assayed high-sensitive Troponin T (hs-cTnT) on day 4, LV remodeling and function, and clinical events at 6-month follow-up. In-hospital results are presented, before completion of 6-mo follow-up.
Results:410 STEMI pts (207 CsA/203 control) had a mean age of 63 ± 12 (SD) yrs. Twenty percent of pts were women, and 14.4% were diabetics. Time from symptom-onset to randomization was 2.5 ± 1.0 h and the median number of EKG leads with ST↑↓ was 5 [4-6] [Q1-Q3]. Location of MI was anterior in 49.8% of pts, TIMI-flow 0 was found in 83.2%, and 4.6% were in Killip class >1. All pts received oral dual anti-platelet treatment, 80.5% a betablocker. There were no serious or life-threatening acute drug reactions, but a non-significant excess of in-hospital clinical events. Baseline clinical and angiographic characteristics did not differ between CsA and controls. Resolution of ST >=70% was found in 49% of controls and 52% of CsA pts (p=0.55). Effects of CsA on LVEF and cTns are reported in the Figure.
Conclusions: A single bolus of CsA just before PPCI is safe, but it does not (1) increase the incidence of ST resolution, (2) decrease cTn, (3) improve LVEF.
Author Disclosures: R. Latini: None. U. Limbruno: None. L. La Vecchia: None. N. Locuratolo: None. A. Costalunga: None. M. Sicuro: None. M. Lombardi: None. L. Staszewsky: None. S. Masson: None. V. Milani: None. S. Barlera: None. A.P. Maggioni: None. F. Ottani: None.
- © 2014 by American Heart Association, Inc.