Effect of IL-1 Blockade With Anakinra on Heart Failure Outcomes in Patients With Anterior Versus Nonanterior ST Elevation Myocardial Infarction.
Effect of IL-1 Blockade With Anakinra on Heart Failure Outcomes in Patients With Anterior Versus Nonanterior ST Elevation Myocardial Infarction.
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DOI：
10.1097/fjc.0000000000001240
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发表时间：
2022-06-01
影响因子：
3
通讯作者：
Abbate, Antonio
中科院分区：
文献类型：
--
作者：
Del Buono, Marco Giuseppe;Damonte, Juan Ignacio;Chiabrando, Juan Guido;Markley, Roshanak;Turlington, Jeremy;Trankle, Cory R.;Kang, Le;Biondi-Zoccai, Giuseppe;Van Tassell, Benjamin W.;Abbate, Antonio
关键词：
ST段抬高型心肌梗死（STEMI）患者存在未来心力衰竭（HF）的风险，尤其是前壁STEMI患者。白细胞介素-1（IL-1）是炎症反应的关键介质，其阻断已成为预防HF事件的潜在治疗策略。本分析的目的是探讨阿那白滞素（一种IL-1受体拮抗剂）对基于前壁与非前壁位置STEMI的HF结局的影响，并探讨这种影响是否通过改善左心室收缩功能和心脏重构介导。我们汇总了三项早期随机临床试验的数据。主要终点是1年随访时全因死亡和新发HF的复合终点。冠状动脉左前降支作为罪犯血管用于识别前STEMI。我们纳入了139例患者，47例（34%）为前壁STEMI，92例（66%）为非前壁STEMI。阿那白滞素显著降低了前部STEMI患者（4例（13%）vs 7例（42%），对数秩p值=0.049）以及非前部STEMI患者（3例[6%] vs 9例[24%]，对数秩p值= 0.014）的死亡或新发HF的联合终点。我们发现阿那白滞素与安慰剂相比，在前壁和非前壁STEMI的左心室射血分数（LVEF）和容积的间期变化方面无显著差异。总之，阿那白滞素与STEMI患者心力衰竭事件的减少有关，无论是前壁或非前壁位置，还是LVEF或心脏重塑的变化。
Patients with ST elevation myocardial infarction (STEMI) are at risk of future heart failure (HF), particularly those with anterior STEMI. Interleukin-1 (IL-1) is a key mediator of the inflammatory response, and its blockade has emerged as a potential therapeutic strategy to prevent HF events. The aim of this analysis was to explore the effects of anakinra, an IL-1 receptor antagonist, on HF outcomes based on anterior versus non-anterior location STEMI and to explore whether this effect is mediated through the amelioration of left ventricular systolic function and cardiac remodeling. We pooled data from three early phase randomized clinical trials. The primary endpoint was a composite of all-cause death and new-onset HF at 1 year follow-up. The left anterior descending coronary artery as culprit vessel was used to identify anterior STEMI. We included 139 patients, 47 (34%) with anterior STEMI and 92 (66%) with non-anterior STEMI. Anakinra significantly reduced the combined endpoint of death or new onset HF in patients with anterior STEMI (4 (13%) vs 7 (42%), log-rank p value=0.049) as well as in patients with non-anterior STEMI (3 [6%] vs 9 [24%], log-rank p value= 0.014). We found no significant differences comparing anakinra versus placebo in interval changes in left ventricular ejection fraction (LVEF) and volumes in anterior and non anterior STEMI. In conclusion, anakinra is associated with a reduction of heart failure events in patients with STEMI, irrespective of anterior or non-anterior location, or of changes in LVEF or cardiac remodeling.