1. Randomized Trial of Interleukin-6 Receptor Inhibition in Patients With Acute ST-Segment Elevation Myocardial Infarction.
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Broch, Kaspar, Anstensrud, Anne Kristine, Woxholt, Sindre, Sharma, Kapil, Tøllefsen, Ingvild Maria, Bendz, Bjørn, Aakhus, Svend, Ueland, Thor, Amundsen, Brage Høyem, Damås, Jan Kristian, Berg, Erlend Sturle, Bjørkelund, Elisabeth, Bendz, Christina, Hopp, Einar, Kleveland, Ola, Stensæth, Knut Haakon, Opdahl, Anders, Kløw, Nils-Einar, Seljeflot, Ingebjørg, and Andersen, Geir Øystein
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INTERLEUKIN-6 receptors , *MYOCARDIAL infarction , *MAGNETIC resonance imaging , *PERCUTANEOUS coronary intervention , *REPERFUSION injury , *MYOCARDIAL revascularization , *THERAPEUTIC use of monoclonal antibodies , *RESEARCH , *MYOCARDIUM , *INTRAVENOUS therapy , *HEART , *MYOCARDIAL ischemia , *RESEARCH methodology , *CELL receptors , *MEDICAL care , *PATIENTS , *CORONARY disease , *MONOCLONAL antibodies , *MEDICAL cooperation , *EVALUATION research , *CARDIOVASCULAR agents , *DIAGNOSTIC imaging , *CARDIOVASCULAR system , *COMPARATIVE studies , *BLIND experiment , *CORONARY arteries , *NECROSIS , *DISEASE complications - Abstract
Background: Prompt myocardial revascularization with percutaneous coronary intervention (PCI) reduces infarct size and improves outcomes in patients with ST-segment elevation myocardial infarction (STEMI). However, as much as 50% of the loss of viable myocardium may be attributed to the reperfusion injury and the associated inflammatory response.Objectives: This study sought to evaluate the effect of the interleukin-6 receptor inhibitor tocilizumab on myocardial salvage in acute STEMI.Methods: The ASSAIL-MI trial was a randomized, double-blind, placebo-controlled trial conducted at 3 high-volume PCI centers in Norway. Patients admitted with STEMI within 6 h of symptom onset were eligible. Consenting patients were randomized in a 1:1 fashion to promptly receive a single infusion of 280 mg tocilizumab or placebo. The primary endpoint was the myocardial salvage index as measured by magnetic resonance imaging after 3 to 7 days.Results: We randomized 101 patients to tocilizumab and 98 patients to placebo. The myocardial salvage index was larger in the tocilizumab group than in the placebo group (adjusted between-group difference 5.6 [95% confidence interval: 0.2 to 11.3] percentage points, p = 0.04). Microvascular obstruction was less extensive in the tocilizumab arm, but there was no significant difference in the final infarct size between the tocilizumab arm and the placebo arm (7.2% vs. 9.1% of myocardial volume, p = 0.08). Adverse events were evenly distributed across the treatment groups.Conclusions: Tocilizumab increased myocardial salvage in patients with acute STEMI. (ASSessing the effect of Anti-IL-6 treatment in Myocardial Infarction [ASSAIL-MI]; NCT03004703). [ABSTRACT FROM AUTHOR]- Published
- 2021
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