Authors

Antonio Abbate, Virginia Commonwealth UniversityFollow
Cory R. Trankle, Virginia Commonwealth University
Leo F. Buckley, MedStar Washington Hospital Center
Michael J. Lipinski, MedStar Washington Hospital Center
Darryn Appleton, Virginia Cardiovascular Specialists
Dinesh Kadariya, Virginia Commonwealth University
Justin M. Canada, Virginia Commonwealth University
Salvatore Carbone, Virginia Commonwealth University
Charlotte S. Roberts, Virginia Commonwealth University
Nayef Abouzaki, Virginia Commonwealth University
Ryan Melchior, Virginia Commonwealth University
Sanah Christopher, Virginia Commonwealth University
Jeremy Turlington, Virginia Commonwealth University
George Mueller, Virginia Commonwealth University
James Garnett, Virginia Cardiovascular Specialists
Christopher Thomas, Virginia Commonwealth University
Roshanak Markley, Virginia Commonwealth University
George F. Wohlford, MedStar Washington Hospital Center
Laura Puckett, Virginia Commonwealth University
Horacio Medina de Chazal, Virginia Commonwealth University
Juan G. Chiabrando, Virginia Commonwealth University
Edoardo Bressi, Virginia Commonwealth University
Marco Giuseppe Del Buono, Virginia Commonwealth University
Aaron Schatz, Virginia Commonwealth University
Chau Vo, Virginia Commonwealth University
Dave L. Dixon, Virginia Commonwealth University
Giuseppe G. Biondi-Zoccai, Sapienza University of Rome
Michael C. Kontos, Virginia Commonwealth University
Benjamin W. Van Tassell, Virginia Commonwealth University

Document Type

Article

Original Publication Date

2020

Journal/Book/Conference Title

Journal of the American Heart Association

Volume

9

Issue

5

First Page

1

Last Page

9

DOI of Original Publication

10.1161/JAHA.119.014941

Comments

Originally published at https://doi.org/10.1161/JAHA.119.014941.

Funded in part by the VCU Libraries Open Access Publishing Fund.

Date of Submission

June 2020

Abstract

Background

ST‐segment–elevation myocardial infarction is associated with an intense acute inflammatory response and risk of heart failure. We tested whether interleukin‐1 blockade with anakinra significantly reduced the area under the curve for hsCRP (high sensitivity C‐reactive protein) levels during the first 14 days in patients with ST‐segment–elevation myocardial infarction (VCUART3 [Virginia Commonwealth University Anakinra Remodeling Trial 3]).

Methods and Results

We conducted a randomized, placebo‐controlled, double‐blind, clinical trial in 99 patients with ST‐segment–elevation 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, 39–120] versus 214 [interquartile range, 131–394] mg·day/L; P<0.001), without significant differences between the anakinra arms. No significant differences were found between anakinra and placebo groups in the interval changes in left ventricular end‐systolic volume (median, 1.4 [interquartile range, −9.8 to 9.8] versus −3.9 [interquartile range, −15.4 to 1.4] mL; P=0.21) or left ventricular ejection fraction (median, 3.9% [interquartile range, −1.6% to 10.2%] versus 2.7% [interquartile range, −1.8% to 9.3%]; P=0.61) at 12 months. The incidence of death or new‐onset 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 ST‐segment–elevation myocardial infarction, interleukin‐1 blockade with anakinra significantly reduces the systemic inflammatory response compared with placebo.

Clinical Trial Registration

URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01950299.

Rights

Copyright © 2020 The Authors. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

Is Part Of

VCU Internal Medicine Publications

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