INSERM UMR 1060, CarMeN Laboratory, University Claude Bernard Lyon1, IHU OPeRa, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677, Lyon, France.
Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium.
Basic Res Cardiol. 2019 Dec 12;115(1):4. doi: 10.1007/s00395-019-0764-8.
Despite promising experimental studies and encouraging proof-of-concept clinical trials, interventions aimed at limiting infarct size have failed to improve clinical outcomes in patients with ST-elevation myocardial infarction (STEMI). Our objective was to examine whether variables (cardiovascular risk factors, comorbidities, post-procedural variables, cotreatments) might be associated with clinical outcomes in STEMI patients independently from infarct size reduction. The present study was based on a post hoc analysis of the CIRCUS trial database (Clinicaltrials.gov NCT01502774) that assessed the clinical benefit of a single intravenous bolus of cyclosporine in 969 patients with anterior STEMI. Since cyclosporine had no detectable effect on clinical outcomes as well as on any measured variable, we here considered the whole study population as one group. Multivariate analysis was performed to address the respective weight of infarct size and variables in clinical outcomes. Multivariate analysis revealed that several variables (including gender, hypertension, renal dysfunction, TIMI flow grade post-PCI < 3, and treatment administered after PCI with betablockers and angiotensin-converting enzyme inhibitors) had per se a significant influence on the occurrence of [death or hospitalization for heart failure] at 1 year. The relative weight of infarct size and variables on the composite endpoint of [death or hospitalization for heart failure] at 1 year was 18% and 82%, respectively. Several variables contribute strongly to the clinical outcomes of STEMI patients suggesting that cardioprotective strategy might not only focus on infarct size reduction.
尽管有有前景的实验研究和令人鼓舞的概念验证临床试验，但旨在限制梗死面积的干预措施并未改善 ST 段抬高型心肌梗死（STEMI）患者的临床结局。我们的目的是研究在 STEMI 患者中，变量（心血管危险因素、合并症、术后变量、联合治疗）是否可能独立于梗死面积缩小与临床结局相关。本研究基于 CIRCUS 试验数据库（Clinicaltrials.gov NCT01502774）的事后分析，该分析评估了单剂量环孢素静脉注射在前壁 STEMI 患者中的临床获益。由于环孢素对临床结局以及任何测量变量均无明显作用，因此我们将整个研究人群视为一组。进行多变量分析以确定梗死面积和变量在临床结局中的相对权重。多变量分析显示，几个变量（包括性别、高血压、肾功能不全、PCI 后 TIMI 血流分级 < 3 级，以及 PCI 后接受β受体阻滞剂和血管紧张素转换酶抑制剂治疗）本身对 1 年时[死亡或心力衰竭住院]的发生有显著影响。梗死面积和变量对 1 年时[死亡或心力衰竭住院]复合终点的相对权重分别为 18%和 82%。几个变量强烈影响 STEMI 患者的临床结局，这表明心脏保护策略可能不仅要关注梗死面积的缩小。
