5 research outputs found
Interleukinâ1 Blockade Inhibits the Acute Inflammatory Response in Patients With STâSegmentâElevation Myocardial Infarction
Background
STâsegmentâelevation myocardial infarction is associated with an intense acute inflammatory response and risk of heart failure. We tested whether interleukinâ1 blockade with anakinra significantly reduced the area under the curve for hsCRP (high sensitivity Câreactive protein) levels during the first 14 days in patients with STâsegmentâelevation myocardial infarction (VCUART3 [Virginia Commonwealth University Anakinra Remodeling Trial 3]).
Methods and Results
We conducted a randomized, placeboâcontrolled, doubleâblind, clinical trial in 99 patients with STâsegmentâelevation myocardial infarction in which patients were assigned to 2 weeks treatment with anakinra once daily (N=33), anakinra twice daily (N=31), or placebo (N=35). hsCRP area under the curve was significantly lower in patients receiving anakinra versus placebo (median, 67 [interquartile range, 39â120] versus 214 [interquartile range, 131â394] mg·day/L; P\u3c0.001), without significant differences between the anakinra arms. No significant differences were found between anakinra and placebo groups in the interval changes in left ventricular endâsystolic volume (median, 1.4 [interquartile range, â9.8 to 9.8] versus â3.9 [interquartile range, â15.4 to 1.4] mL; P=0.21) or left ventricular ejection fraction (median, 3.9% [interquartile range, â1.6% to 10.2%] versus 2.7% [interquartile range, â1.8% to 9.3%]; P=0.61) at 12 months. The incidence of death or newâonset heart failure or of death and hospitalization for heart failure was significantly lower with anakinra versus placebo (9.4% versus 25.7% [P=0.046] and 0% versus 11.4% [P=0.011], respectively), without difference between the anakinra arms. The incidence of serious infection was not different between anakinra and placebo groups (14% versus 14%; P=0.98). Injection site reactions occurred more frequently in patients receiving anakinra (22%) versus placebo (3%; P=0.016).
Conclusions
In patients presenting with STâsegmentâelevation myocardial infarction, interleukinâ1 blockade with anakinra significantly reduces the systemic inflammatory response compared with placebo.
Clinical Trial Registration
URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01950299