Pharmacological conditioning: overview of clinical studies demonstrating an protective effect of pharmacological conditioning in patients with STEMI undergoing primary PCI
| Strategy and study | Treatment | N | Main results | Remarks |
|---|---|---|---|---|
| Adenosine | ||||
| Kloner et al30 | 3 h intravenous infusion at high or low dose started before PCI or at time of thrombolysis | 2118 | Reduced mortality and infarct size in patients with duration of symptoms <3.17 h treated with thrombolysis | All TIMI flows. PCI in 40% |
| Garcia-Dorado et al25 | Intracoronary bolus adenosine before PCI | 201 | No difference in infarct size by CMR | Relative 27% reduction in infarct size in the patients with duration of symptoms <200 min |
| Atrial natriuretic peptide | ||||
| Kitakaze et al29 | 72 h intravenous infusion started before PCI | 569 | 15% relative reduction in AUC of CK and 2% absolute increase in LVEF. Reduced cardiac death and heart failure (HR 0.27) | All TIMI flows |
| FX06 | ||||
| Hallen et al26 | Intravenous bolus before and during PCI | 234 | 50% relative reduction in infarct size in the subgroup of patients with duration of symptom <3 h, but no effect in the overall population | |
| Cyclosporin A | ||||
| Piot et al22 | Intravenous bolus before PCI | 58 | 40% relative reduction in AUC of CK. 20% relative reduction in infarct size by CMR. Smaller infarct size adjusted for AAR. No difference in LVEF | |
| Glucose–insulin–potassium (GIK) | ||||
| Selker et al32 | 12 h intravenous infusion started before PCI in the prehospital phase | 357 | No difference in progression to infarction. In patients with STEMI, 75% relative reduction in infarct size by SPECT and smaller in-hospital mortality and cardiac arrest (HR 0.39) | Patients with suspected acute coronary syndrome were included |
| Exenatide | ||||
| Lønborg et al23 | 6 h intravenous infusion started 15 minutes before PCI | 105 | 15% increase in myocardial salvage by CMR and reduced infarct size adjusted for AAR. No significant difference in infarct size, troponin I or LVEF | 30% relative reduction in infarct size in patients with system delay <132 min |
| Bernink et al24 | 72 h intravenous infusion started before PCI | 39 | No difference in infarct size/AAR. 26% relative reduction in infarct size/AAR ratio (p=0.09) by CMR in patients with TIMI 0/1 (n=23) | |
| Woo et al33 | Intravenous and subcutaneous bolus before PCI and subcutaneous bolus for 2 days | 58 | 50% relative reduction in infarct size by CMR. Reduction in AUC of troponin I and CKMB. Improvement in global longitudinal strain and e/é. No effect on LVEF | |
| Metoprolol | ||||
| Ibanez et al27 | Intravenous bolus before PCI | 220 | 19% relative reduction in infarct size by CMR and 3% absolute increase in LVEF. Peak and AUC CK was also reduced and myocardial salvage increased. 4% absolute increase in LVEF at 6 months and reduced admission for heart failure (HR 0.32) | Only Killip class 1 or 2 and anterior infarction. The effect was only seen among patients with pre-PCI TIMI flow 0 or 1 |
| Nitrite | ||||
| Jones et al28 | Intracoronary bolus of sodium nitrite before PCI | 80 | 19% relative increase in salvage index by CMR. No difference in infarct size or AUC CK or troponin T. Significantly smaller infarct size among patients with TIMI 0/1 | All TIMI flows |
AAR, area at risk; AUC, area under the curve; CK-MB, creatine kinase myoglobin band; CMR, cardiovascular magnetic resonance; LAD, left anterior descending artery; LVESV, LV end systolic volume; mPTP, mitochondrial permeability transition pore; MVO, microvascular obstruction; PCI, percutaneous coronary intervention; RCA, right coronary artery; SPECT, single-proton emission CT; STEMI, ST-segment elevation myocardial infarction; TIMI, thrombolysis in myocardial infarction.