No benefit of additional treatment with exenatide in patients with an acute myocardial infarction

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• 作者：Sebastiaan T. Roos^a ; ^b ; Leo Timmers^c ; Paul S. Biesbroek^a ; ^b ; Robin Nijveldt^a ; Otto Kamp^a ; ^b ; Albert C. van Rossum^a ; ^b ; Gerardus P.J. van Hout^c ; Pieter R. Stella^c ; Pieter A. Doevendans^c ; Paul Knaapen^a ; Birgitta K. Velthuis^d ; Niels van Royen^a ; Michiel Voskuil^c ; Alex Nap^a ; Yolande Appelman^a ; ^b ; ^{y.appelman@vumc.nl" class="auth_mail" title="E-mail the corresponding author}
• 关键词：AAR ; area at risk ; EDV ; end diastolic volume ; ESA ; endocardial surface area ; ESV ; end systolic volume ; GLP-1 ; glucagon-like-peptide-1 ; LGE ; late gadolinium enhancement ; LVEF ; left ventricular ejection fraction ; MSI ; myocardial salvage index ; MVO ; microvascular obstruction ; T2  ; W ; T2 weighted
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：1 October 2016
• 年：2016
• 卷：220
• 期：Complete
• 页码：809-814
• 全文大小：484 K

文摘

This double blinded, placebo controlled randomized clinical trial studies the effect of exenatide on myocardial infarct size. The glucagon-like peptide-1 receptor agonist exenatide has possible cardioprotective properties during reperfusion after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.

Methods

191 patients were randomly assigned to intravenous exenatide or placebo initiated prior to percutaneous coronary intervention using 10 μg/h for 30 min followed by 0.84 μg/h for 72 h. Patients with a previous myocardial infarction, Trombolysis in Myocardial Infarction flow 2 or 3, multi-vessel disease, or diabetes were excluded. Magnetic resonance imaging (MRI) was performed to determine infarct size, area at risk (AAR) (using T2-weighted hyperintensity (T2W) and late enhancement endocardial surface area (ESA)). The primary endpoint was of 4-month final infarct size, corrected for the AAR measured in the acute phase using MRI.

Results

After exclusion, 91 patients (age 57.4 ± 10.1 years, 76% male) completed the protocol. There were no baseline differences between groups. No difference was found in infarct size corrected for the AAR in the exenatide group compared to the placebo group (37.1 ± 18.8 vs. 39.3 ± 20.1%, p = 0.662). There was also no difference in infarct size (18.8 ± 13.2 vs. 18.8 ± 11.3% of left ventricular mass, p = 0.965). No major adverse cardiac events occurred during the in-hospital phase.

Conclusion

Exenatide did not reduce myocardial infarct size expressed as a percentage of AAR in ST elevated myocardial infarction patients successfully treated with percutaneous coronary intervention.