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Differential Outcomes With Edetate Disodium-Based Treatment Among Stable Post Anterior vs. Non-Anterior Myocardial Infarction Patients
- Source :
- Cardiovascular Revascularization Medicine. 21:1389-1395
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- Background The Trial to Assess Chelation Therapy (TACT) found that chelation therapy significantly reduced clinical events in patients with a history of myocardial infarction (MI). The initial report of TACT included the observation of an interaction between edetate disodium infusions and MI location, as well as diabetes. Thus, we examined in greater detail the effect of edetate disodium chelation therapy as a function of MI location and diabetes. Methods Patients (n = 1708) at least 6 weeks post-MI and age ≥ 50 were randomized to receive 40 infusions of a 500 mL chelation solution or placebo (median follow-up 55 months). The effect of edetate disodium on the primary outcome (all-cause mortality, MI, stroke, hospitalization for angina, or coronary revascularization) was assessed as a function of MI location using log-rank test and Cox regression model, adjusting for other prognostic variables. Results Among patients with post anterior MI (n = 674), chelation was associated with a lower risk of the primary endpoint (HR 0.63, 95% CI 0.47–0.86, p = 0.003) among anterior MI patients, but not in post non-anterior MI (n = 1034) patients (HR 0.96, 95% CI 0.77–1.20, p = 0.702) (p-for-interaction = 0.032). The point estimates for each component of the primary endpoint favored chelation therapy. The differing treatment effect in patients with post anterior vs. non-anterior MI was consistent among patients with or without diabetes and remained significant after adjusting for other prognostic variables (p Conclusions Edetate disodium infusions reduced the risk of cardiovascular events among patients with a prior anterior MI. Future studies should focus on replicating these results and understanding the mechanisms of benefit.
- Subjects :
- medicine.medical_specialty
Myocardial Infarction
030204 cardiovascular system & hematology
Lower risk
Placebo
Angina Pectoris
Angina
03 medical and health sciences
0302 clinical medicine
Diabetes mellitus
Internal medicine
medicine
Clinical endpoint
Humans
030212 general & internal medicine
Chelation therapy
Myocardial infarction
Stroke
Edetic Acid
Chelating Agents
business.industry
General Medicine
Middle Aged
medicine.disease
Chelation Therapy
Treatment Outcome
Cardiology
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 15538389
- Volume :
- 21
- Database :
- OpenAIRE
- Journal :
- Cardiovascular Revascularization Medicine
- Accession number :
- edsair.doi.dedup.....4d41f7df67f0de3cdeae89d0a371598c