Interleukin-1 blockade with anakinra and heart failure following ST-segment elevation myocardial infarction: results from a pooled analysis of the VCUART clinical trials
Interleukin-1 blockade with anakinra and heart failure following ST-segment elevation myocardial infarction: results from a pooled analysis of the VCUART clinical trials
复制标题
DOI：
10.1093/ehjcvp/pvab075
复制
发表时间：
2021-10-07
影响因子：
7.1
通讯作者：
Van Tassell, Benjamin W.
中科院分区：
文献类型：
--
作者：
Abbate, Antonio;Wohlford, George F.;Van Tassell, Benjamin W.
ST段抬高型心肌梗死（STEMI）与急性炎症反应密切相关，并增加了死亡和心力衰竭（HF）的风险。在这项研究中，我们试图评估阿那白滞素，一种重组白细胞介素-1受体拮抗剂，对HF发病率的影响。方法和结果我们对三项早期随机临床试验进行了汇总分析。终点包括全因死亡和新发HF的复合终点，以及1年随访时全因死亡和因HF住院的复合终点。还记录了安全性事件，包括注射部位反应和严重感染。我们分析了来自三项独立试验的139例STEMI患者：VCUART（N = 10），VCUART 2（N = 30）和VCUART 3（N = 99）。其中，84名（60%）患者随机接受阿那白滞素治疗，55名（40%）患者随机接受安慰剂治疗。阿那白滞素治疗显著降低了全因死亡或新发HF的发生率（7 [8.2%] vs. 16 [29.1%]，对数秩P = 0.002）和全因死亡或HF住院的发生率（0 [0] vs. 5 [9.1%]，对数秩P = 0.007）。接受阿那白滞素治疗的患者注射部位反应明显更高（19例[22.6%] vs. 3例[5.5%]，P = 0.016），但严重感染的发生率无显著差异（11例[13.1%] vs. 7例[12.7%]，P = 0.435）。阿那白滞素治疗显著降低了基线和14天之间高敏C反应蛋白的曲线下面积（75.48 [41.7-147.47] vs. 222.82 [117.22-399.28] mg/天/L，P < 0.001）。结论ST段抬高型心肌梗死患者应用阿那白滞素阻断IL-1治疗14 d可降低新发心力衰竭的发生率或1年后因心力衰竭住院的发生率。
Aims ST-segment elevation myocardial infarction (STEMI) is associated with an intense acute inflammatory response and an increased risk of death and heart failure (HF). In this study, we sought to evaluate the effect of anakinra, a recombinant interleukin-1 receptor antagonist, on the incidence of HF. Methods and results We performed a pooled analysis of three early phase randomized clinical trials. The endpoints included the composite of all-cause death and new-onset HF, and the composite of all-cause death and hospitalization for HF at 1-year follow-up. Safety events, including injection site reaction and serious infections, were also recorded. We analysed 139 patients with STEMI from three separate trials: VCUART (N = 10), VCUART2 (N = 30), and VCUART3 (N = 99). Of these, 84 (60%) patients were randomized to anakinra and 55 (40%) to placebo. Treatment with anakinra significantly reduced the incidence of all-cause death or new-onset HF (7 [8.2%] vs. 16 [29.1%], log-rank P = 0.002) and of all-cause death or HF hospitalization (0 [0] vs. 5 [9.1%], log-rank P = 0.007). Patients treated with anakinra had significantly higher injection site reactions (19 [22.6%] vs. 3 [5.5%], P = 0.016) without a significant difference in the incidence of serious infections (11 [13.1%] vs. 7 [12.7%], P = 0.435). Treatment with anakinra significantly reduced the area under the curve for high-sensitivity C-reactive protein between baseline and 14 days (75.48 [41.7-147.47] vs. 222.82 [117.22-399.28] mg day/L, P < 0.001). Conclusion IL-1 blockade with anakinra for 14 days in patients with STEMI reduces the incidence of new-onset HF or hospitalization for HF at 1 year following STEMI.