101. Effect of COMBinAtion therapy with remote ischemic conditioning and exenatide on the Myocardial Infarct size: a two-by-two factorial randomized trial (COMBAT-MI).
- Author
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García Del Blanco B, Otaegui I, Rodríguez-Palomares JF, Bayés-Genis A, Fernández-Nofrerías E, Vilalta Del Olmo V, Carrillo X, Ibáñez B, Worner F, Casanova J, Pueo E, González-Juanatey JR, López-Pais J, Bardají A, Bonet G, Fuertes M, Rodríguez-Sinovas A, Ruiz-Meana M, Inserte J, Barba I, Gómez-Talavera S, Martí G, Serra B, Bellera N, Ojeda-Ramos M, Cuellar H, Valente F, Carmona MÁ, Miró-Casas E, Marsal JR, Sambola A, Lidón RM, Bañeras J, Elízaga J, Padilla F, Barrabés JA, Hausenloy DJ, Ferreira-González I, and García-Dorado D
- Subjects
- Aged, Combined Modality Therapy, Double-Blind Method, Exenatide adverse effects, Female, Humans, Incretins adverse effects, Magnetic Resonance Imaging, Cine, Male, Middle Aged, Prospective Studies, Regional Blood Flow, ST Elevation Myocardial Infarction diagnostic imaging, ST Elevation Myocardial Infarction pathology, ST Elevation Myocardial Infarction physiopathology, Spain, Time Factors, Treatment Outcome, Ventricular Function, Left, Arm blood supply, Exenatide therapeutic use, Incretins therapeutic use, Ischemic Preconditioning, Myocardium pathology, Percutaneous Coronary Intervention adverse effects, ST Elevation Myocardial Infarction therapy
- Abstract
Remote ischemic conditioning (RIC) and the GLP-1 analog exenatide activate different cardioprotective pathways and may have additive effects on infarct size (IS). Here, we aimed to assess the efficacy of RIC as compared with sham procedure, and of exenatide, as compared with placebo, and the interaction between both, to reduce IS in humans. We designed a two-by-two factorial, randomized controlled, blinded, multicenter, clinical trial. Patients with ST-segment elevation myocardial infarction receiving primary percutaneous coronary intervention (PPCI) within 6 h of symptoms were randomized to RIC or sham procedure and exenatide or matching placebo. The primary outcome was IS measured by late gadolinium enhancement in cardiac magnetic resonance performed 3-7 days after PPCI. The secondary outcomes were myocardial salvage index, transmurality index, left ventricular ejection fraction and relative microvascular obstruction volume. A total of 378 patients were randomly allocated, and after applying exclusion criteria, 222 patients were available for analysis. There were no significant interactions between the two randomization factors on the primary or secondary outcomes. IS was similar between groups for the RIC (24 ± 11.8% in the RIC group vs 23.7 ± 10.9% in the sham group, P = 0.827) and the exenatide hypotheses (25.1 ± 11.5% in the exenatide group vs 22.5 ± 10.9% in the placebo group, P = 0.092). There were no effects with either RIC or exenatide on the secondary outcomes. Unexpected adverse events or side effects of RIC and exenatide were not observed. In conclusion, neither RIC nor exenatide, or its combination, were able to reduce IS in STEMI patients when administered as an adjunct to PPCI.
- Published
- 2021
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