Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
Circ Cardiovasc Interv. 2012 Apr;5(2):288-95. doi: 10.1161/CIRCINTERVENTIONS.112.968388. Epub 2012 Apr 10.
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.
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).
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.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00835848.
在接受经皮冠状动脉介入治疗的 ST 段抬高型心肌梗死（STEMI）患者中，西他列汀已被证明具有心脏保护作用。本事后分析研究的目的是评估西他列汀与系统延迟的关系，系统延迟定义为首次医疗接触至首次球囊扩张的时间。
STEMI 患者和溶栓治疗心肌梗死血流 0/1 级患者被随机分为静脉内给予西他列汀或安慰剂持续输注。研究治疗于介入前 15 分钟开始，并在术后 6 小时内维持。根据中位系统延迟（132 分钟）对患者进行分层。通过心血管磁共振测量最终梗死面积和心肌危险区。在系统延迟≤132 分钟的患者中（n=74），西他列汀治疗导致梗死面积较小（9 克[四分位距（IQR），4-13]比 13 克[IQR，8-24]，P=0.008，对应于左心室的 8%[IQR，4-12]比 11%[IQR，7-17]，P=0.015）。在调整心肌危险区后进行回归分析，西他列汀组的数据点明显低于安慰剂组（P=0.006）。在系统延迟>132 分钟的患者中（n=74），以克（P=0.49）或百分比（P=0.46）表示的梗死面积无差异。在梗死面积方面，系统延迟（小于或等于中位数与大于中位数）与治疗分配之间存在显著的交互作用（P=0.018）。
在本事后分析中，在系统延迟较短的患者中，西他列汀治疗与最终梗死面积减少 30%相关，而在系统延迟较长的患者中未见心脏保护作用。然而，这一发现需要在更大的研究中得到证实。
