Exenatide reduces final infarct size in patients with ST-segment-elevation myocardial infarction and short-duration of ischemia.

J Lønborg; Henning Skov Kelbæk; Niels Grove Vejlstrup; HE Bøtker; WY Kim; Lene Holmvang; Erik Jørgensen; Steffen Helqvist; Kari I. Saunanaki; CJ Terkelsen; MM Schoos; Lars Valeur Køber; P Clemmensen; Marek Treiman; T Engstrøm

doi:10.1161/CIRCINTERVENTIONS.112.968388

Exenatide reduces final infarct size in patients with ST-segment-elevation myocardial infarction and short-duration of ischemia.

J Lønborg, Henning Skov Kelbæk, Niels Grove Vejlstrup, HE Bøtker, WY Kim, Lene Holmvang, Erik Jørgensen, Steffen Helqvist, Kari I. Saunanaki, CJ Terkelsen, MM Schoos, Lars Valeur Køber, P Clemmensen, Marek Treiman, T Engstrøm

Physiology of circulation, kidney and lung

149 Citationer (Scopus)

Abstract

Background-Exenatide has been demonstrated to be cardioprotective as an adjunct to primary percutaneous coronary intervention in patients with ST-segment-elevation myocardial infarction (STEMI). The aim of the post hoc analysis study was to evaluate the effect of exenatide in relation to system delay, defined as time from first medical contact to first balloon. Methods and Results-Patients with STEMI and Thrombolysis In Myocardial Infarction flow 0/1 were randomly assigned to intravenous exenatide or placebo continuous infusion. Study treatment was commenced 15 minutes before intervention and maintained for 6 hours after the procedure. The patients were stratified according to median system delay (132 minutes). Final infarct size and myocardial area at risk were measured by cardiovascular magnetic resonance. Among patients with a system delay ≤132 minutes (n=74), treatment with exenatide resulted in a smaller infarct size (9 grams [interquartile range (IQR), 4-13] versus 13 grams [IQR, 8-24], P=0.008, corresponding to 8% [IQR, 4-12] versus 11% [IQR, 7-17] of the left ventricle, P=0.015). In a regression analysis adjusting for myocardial area at risk the data points of the exenatide group lay significantly lower than for the placebo group (P=0.006). In the patients with system delay >132 minutes (n=74) no difference was observed in infarct size expressed as grams (P=0.49) or percentage (P=0.46). There was significant interaction between system delay (less than or equal to median versus greater than median) and treatment allocation in terms of infarct size (P=0.018). Conclusions-In this post hoc analysis, exenatide treatment was associated with a 30% decrease in final infarct size in patients with short system delay, whereas no cardioprotective effect in patients with long system delay was seen. However, this finding must be confirmed in larger studies. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00835848.

Originalsprog	Engelsk
Tidsskrift	Circulation. Cardiovascular Interventions
Vol/bind	5
Udgave nummer	2
Sider (fra-til)	288-295
Antal sider	8
ISSN	1941-7640
DOI	https://doi.org/10.1161/CIRCINTERVENTIONS.112.968388
Status	Udgivet - apr. 2012

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10.1161/CIRCINTERVENTIONS.112.968388

Citationsformater

Lønborg, J., Kelbæk, H. S., Vejlstrup, N. G., Bøtker, HE., Kim, WY., Holmvang, L., Jørgensen, E., Helqvist, S., Saunanaki, K. I., Terkelsen, CJ., Schoos, MM., Køber, L. V., Clemmensen, P., Treiman, M., & Engstrøm, T. (2012). Exenatide reduces final infarct size in patients with ST-segment-elevation myocardial infarction and short-duration of ischemia. Circulation. Cardiovascular Interventions, 5(2), 288-295. https://doi.org/10.1161/CIRCINTERVENTIONS.112.968388

Lønborg, J, Kelbæk, HS, Vejlstrup, NG, Bøtker, HE, Kim, WY, Holmvang, L, Jørgensen, E, Helqvist, S, Saunanaki, KI, Terkelsen, CJ, Schoos, MM, Køber, LV, Clemmensen, P, Treiman, M & Engstrøm, T 2012, 'Exenatide reduces final infarct size in patients with ST-segment-elevation myocardial infarction and short-duration of ischemia.', Circulation. Cardiovascular Interventions, bind 5, nr. 2, s. 288-295. https://doi.org/10.1161/CIRCINTERVENTIONS.112.968388

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title = "Exenatide reduces final infarct size in patients with ST-segment-elevation myocardial infarction and short-duration of ischemia.",

abstract = "Background-Exenatide has been demonstrated to be cardioprotective as an adjunct to primary percutaneous coronary intervention in patients with ST-segment-elevation myocardial infarction (STEMI). The aim of the post hoc analysis study was to evaluate the effect of exenatide in relation to system delay, defined as time from first medical contact to first balloon. Methods and Results-Patients with STEMI and Thrombolysis In Myocardial Infarction flow 0/1 were randomly assigned to intravenous exenatide or placebo continuous infusion. Study treatment was commenced 15 minutes before intervention and maintained for 6 hours after the procedure. The patients were stratified according to median system delay (132 minutes). Final infarct size and myocardial area at risk were measured by cardiovascular magnetic resonance. Among patients with a system delay ≤132 minutes (n=74), treatment with exenatide resulted in a smaller infarct size (9 grams [interquartile range (IQR), 4-13] versus 13 grams [IQR, 8-24], P=0.008, corresponding to 8% [IQR, 4-12] versus 11% [IQR, 7-17] of the left ventricle, P=0.015). In a regression analysis adjusting for myocardial area at risk the data points of the exenatide group lay significantly lower than for the placebo group (P=0.006). In the patients with system delay >132 minutes (n=74) no difference was observed in infarct size expressed as grams (P=0.49) or percentage (P=0.46). There was significant interaction between system delay (less than or equal to median versus greater than median) and treatment allocation in terms of infarct size (P=0.018). Conclusions-In this post hoc analysis, exenatide treatment was associated with a 30% decrease in final infarct size in patients with short system delay, whereas no cardioprotective effect in patients with long system delay was seen. However, this finding must be confirmed in larger studies. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00835848.",

author = "J L{\o}nborg and Kelb{\ae}k, {Henning Skov} and Vejlstrup, {Niels Grove} and HE B{\o}tker and WY Kim and Lene Holmvang and Erik J{\o}rgensen and Steffen Helqvist and Saunanaki, {Kari I.} and CJ Terkelsen and MM Schoos and K{\o}ber, {Lars Valeur} and P Clemmensen and Marek Treiman and T Engstr{\o}m",

year = "2012",

month = apr,

doi = "10.1161/CIRCINTERVENTIONS.112.968388",

language = "English",

volume = "5",

pages = "288--295",

journal = "Circulation: Cardiovascular Interventions",

issn = "1941-7640",

publisher = "Lippincott Williams & Wilkins",

number = "2",

}

TY - JOUR

T1 - Exenatide reduces final infarct size in patients with ST-segment-elevation myocardial infarction and short-duration of ischemia.

AU - Lønborg, J

AU - Kelbæk, Henning Skov

AU - Vejlstrup, Niels Grove

AU - Bøtker, HE

AU - Kim, WY

AU - Holmvang, Lene

AU - Jørgensen, Erik

AU - Helqvist, Steffen

AU - Saunanaki, Kari I.

AU - Terkelsen, CJ

AU - Schoos, MM

AU - Køber, Lars Valeur

AU - Clemmensen, P

AU - Treiman, Marek

AU - Engstrøm, T

PY - 2012/4

Y1 - 2012/4

N2 - Background-Exenatide has been demonstrated to be cardioprotective as an adjunct to primary percutaneous coronary intervention in patients with ST-segment-elevation myocardial infarction (STEMI). The aim of the post hoc analysis study was to evaluate the effect of exenatide in relation to system delay, defined as time from first medical contact to first balloon. Methods and Results-Patients with STEMI and Thrombolysis In Myocardial Infarction flow 0/1 were randomly assigned to intravenous exenatide or placebo continuous infusion. Study treatment was commenced 15 minutes before intervention and maintained for 6 hours after the procedure. The patients were stratified according to median system delay (132 minutes). Final infarct size and myocardial area at risk were measured by cardiovascular magnetic resonance. Among patients with a system delay ≤132 minutes (n=74), treatment with exenatide resulted in a smaller infarct size (9 grams [interquartile range (IQR), 4-13] versus 13 grams [IQR, 8-24], P=0.008, corresponding to 8% [IQR, 4-12] versus 11% [IQR, 7-17] of the left ventricle, P=0.015). In a regression analysis adjusting for myocardial area at risk the data points of the exenatide group lay significantly lower than for the placebo group (P=0.006). In the patients with system delay >132 minutes (n=74) no difference was observed in infarct size expressed as grams (P=0.49) or percentage (P=0.46). There was significant interaction between system delay (less than or equal to median versus greater than median) and treatment allocation in terms of infarct size (P=0.018). Conclusions-In this post hoc analysis, exenatide treatment was associated with a 30% decrease in final infarct size in patients with short system delay, whereas no cardioprotective effect in patients with long system delay was seen. However, this finding must be confirmed in larger studies. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00835848.

AB - Background-Exenatide has been demonstrated to be cardioprotective as an adjunct to primary percutaneous coronary intervention in patients with ST-segment-elevation myocardial infarction (STEMI). The aim of the post hoc analysis study was to evaluate the effect of exenatide in relation to system delay, defined as time from first medical contact to first balloon. Methods and Results-Patients with STEMI and Thrombolysis In Myocardial Infarction flow 0/1 were randomly assigned to intravenous exenatide or placebo continuous infusion. Study treatment was commenced 15 minutes before intervention and maintained for 6 hours after the procedure. The patients were stratified according to median system delay (132 minutes). Final infarct size and myocardial area at risk were measured by cardiovascular magnetic resonance. Among patients with a system delay ≤132 minutes (n=74), treatment with exenatide resulted in a smaller infarct size (9 grams [interquartile range (IQR), 4-13] versus 13 grams [IQR, 8-24], P=0.008, corresponding to 8% [IQR, 4-12] versus 11% [IQR, 7-17] of the left ventricle, P=0.015). In a regression analysis adjusting for myocardial area at risk the data points of the exenatide group lay significantly lower than for the placebo group (P=0.006). In the patients with system delay >132 minutes (n=74) no difference was observed in infarct size expressed as grams (P=0.49) or percentage (P=0.46). There was significant interaction between system delay (less than or equal to median versus greater than median) and treatment allocation in terms of infarct size (P=0.018). Conclusions-In this post hoc analysis, exenatide treatment was associated with a 30% decrease in final infarct size in patients with short system delay, whereas no cardioprotective effect in patients with long system delay was seen. However, this finding must be confirmed in larger studies. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00835848.

U2 - 10.1161/CIRCINTERVENTIONS.112.968388

DO - 10.1161/CIRCINTERVENTIONS.112.968388

M3 - Journal article

C2 - 22496084

SN - 1941-7640

VL - 5

SP - 288

EP - 295

JO - Circulation: Cardiovascular Interventions

JF - Circulation: Cardiovascular Interventions

IS - 2

ER -

Exenatide reduces final infarct size in patients with ST-segment-elevation myocardial infarction and short-duration of ischemia.

Abstract

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