Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.F.L.), USA.
Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, FL (G.A.L.), USA.
Cardiovasc Revasc Med. 2020 Nov;21(11):1389-1395. doi: 10.1016/j.carrev.2020.04.005. Epub 2020 Apr 7.
The Trial to Assess Chelation Therapy (TACT) found that chelation therapy significantly reduced clinical events in patients with a history of myocardial infarction (MI). The initial report of TACT included the observation of an interaction between edetate disodium infusions and MI location, as well as diabetes. Thus, we examined in greater detail the effect of edetate disodium chelation therapy as a function of MI location and diabetes.
Patients (n = 1708) at least 6 weeks post-MI and age ≥ 50 were randomized to receive 40 infusions of a 500 mL chelation solution or placebo (median follow-up 55 months). The effect of edetate disodium on the primary outcome (all-cause mortality, MI, stroke, hospitalization for angina, or coronary revascularization) was assessed as a function of MI location using log-rank test and Cox regression model, adjusting for other prognostic variables.
Among patients with post anterior MI (n = 674), chelation was associated with a lower risk of the primary endpoint (HR 0.63, 95% CI 0.47-0.86, p = 0.003) among anterior MI patients, but not in post non-anterior MI (n = 1034) patients (HR 0.96, 95% CI 0.77-1.20, p = 0.702) (p-for-interaction = 0.032). The point estimates for each component of the primary endpoint favored chelation therapy. The differing treatment effect in patients with post anterior vs. non-anterior MI was consistent among patients with or without diabetes and remained significant after adjusting for other prognostic variables (p < 0.01).
Edetate disodium infusions reduced the risk of cardiovascular events among patients with a prior anterior MI. Future studies should focus on replicating these results and understanding the mechanisms of benefit.
评估螯合疗法试验（TACT）发现，螯合疗法可显著降低有心肌梗死（MI）病史的患者的临床事件发生率。TACT 的初始报告包括观察到依地酸二钠输注与 MI 部位以及糖尿病之间的相互作用。因此，我们更详细地研究了依地酸二钠螯合疗法作为 MI 部位和糖尿病的函数的效果。
至少在 MI 后 6 周且年龄≥50 岁的患者被随机分配接受 40 次 500mL 螯合溶液或安慰剂输注（中位随访 55 个月）。使用对数秩检验和 Cox 回归模型评估依地酸二钠对主要结局（全因死亡率、MI、卒中和因心绞痛住院或冠状动脉血运重建）的影响，该模型根据 MI 部位进行调整，同时调整其他预后变量。
在有前壁 MI 的患者（n=674）中，与非前壁 MI（n=1034）患者相比，螯合疗法与较低的主要终点风险相关（HR 0.63，95%CI 0.47-0.86，p=0.003）（p 为交互作用=0.032）。每个主要终点组成部分的点估计均有利于螯合疗法。在前壁 MI 患者和非前壁 MI 患者中，后前壁 MI 与非前壁 MI 患者之间的治疗效果差异一致，并且在调整其他预后变量后仍然显著（p<0.01）。
依地酸二钠输注降低了有先前前壁 MI 的患者的心血管事件风险。未来的研究应侧重于复制这些结果并了解获益的机制。
