Abstract 18454: Inhaled Nitric Oxide in ST-Elevation Myocardial Infarction: Two Year Follow-up of the NOMI Study
Introduction: Inhaled nitric oxide (iNO) during reperfusion confers cardioprotection in experimental myocardial ischemia-reperfusion injury. In the multicenter controlled NOMI trial (Nitric Oxide for inhalation in ST-elevation Myocardial Infarction), we randomized 250 patients with first-time STEMI to inhale oxygen with (iNO) or without (CON) 80 ppm NO for 4 hours following successful PCI. The primary efficacy endpoint, infarct size as a fraction of the LV mass assessed by MRI at 72 hours, was neutral, potentially attributable to an interaction between iNO and pharmacological nitrovasodilator use. The greater systolic LV function recovery at 4 months’ follow-up suggests that iNO-mediated effects may predominantly translate in long-term clinical benefit. We here report the 2 year clinical follow-up of NOMI.
Methods: Patients enrolled in NOMI were followed-up for 2 years. The clinical endpoint was the composite of all-cause death, nonfatal recurrent MI, recurrent ischemia, stroke and rehospitalization. For all-cause mortality and the composite clinical endpoint, the log-rank test was used. For the other components of the composite endpoint the Pepe-Mori test was used to correct for competing risks.
Results: In total, 245 patients completed follow-up. There was no difference in the composite clinical endpoint at 2 years (31.3% versus 33.0%, p=0.54, figure 1). Although the event rates for reinfarction and recurrent ischemia were high, there was no difference between iNO and CON (5.3% vs 6.7%, p=0.49 and 18.5% vs 16.7%, p=0.71 respectively). At 2 years, all-cause mortality was 7.6% in iNO versus 8.0% in CON, p=0.87.
Conclusion: At 2 years follow-up, iNO during reperfusion in STEMI does not result in a better clinical outcome. Novel treatments expected to improve maladaptive LV remodeling or survival in STEMI patients mandate inclusion of patients with larger myocardial infarctions or with chronic ischemic cardiomyopathy.
Author Disclosures: M. Vanhaverbeke: None. J. Bogaert: None. B. Merkely: None. J. Zalewski: None. P. Vranckx: None. P. Pokreisz: None. P. Sinnaeve: None. A. Belmans: None. S. Janssens: None.
- © 2016 by American Heart Association, Inc.