Cyclosporine does not improve outcomes after PCI

August 30, 2015, European Society of Cardiology

The immunosuppressant drug cyclosporine did not improve clinical outcomes compared to placebo in patients receiving percutaneous coronary intervention (PCI) for the more severe form of heart attack known as ST-segment elevation myocardial infarction (STEMI).

Results of the CIRCUS trial, presented today in a Hot Line session at ESC Congress 2015, and published simultaneously in the New England Journal of Medicine. showed that the drug, administered prior to PCI, had no impact on a composite of all-cause death, hospitalisation for - or worsening of - heart failure, or adverse left ventricular remodelling at one year.

"We were very surprised and disappointed," said lead investigator Michel Ovize, MD, PhD, from Claude Bernard University, in Lyon, France.

"There is substantial experimental evidence that cyclosporine can reduce infarct size and improve cardiac function, and we previously published a small-size phase II trial suggesting that cyclosporine may reduce infarct size in STEMI (N Engl J Med. 2008 Jul 31;359(5):473-81). Obviously, the larger phase III CIRCUS study did not confirm this, and the reason for this discrepancy in unclear."

The study included patients with anterior STEMI undergoing PCI within 12 hours of symptom onset and with complete occlusion of the culprit coronary artery.

Patients were randomly assigned to receive a 2.5 mg/kg intravenous bolus injection of cyclosporine (n=395) or matching placebo (n=396) before coronary recanalization.

The rate of the primary outcome was 59.0% in the cyclosporine group versus 58.1% in the control group (odds ratio 1.04; P=0.77), and cyclosporine also did not reduce the incidence of separate clinical components of the primary outcome or other events including recurrent infarction, unstable angina or stroke.

"The real-life setting of anterior STEMI is quite different from animal models and, in addition, treatment of patients has changed in several ways since our previous study," said Professor Ovize. "Targeting reperfusion injury to reduce infarct size remains a major challenge for PCI cardiologists in charge of STEMI patients whose cardiovascular risk remains much too high."

Explore further: Cardiac prognosis bright for STEMI survivors post-PCI

Related Stories

Cardiac prognosis bright for STEMI survivors post-PCI

November 11, 2014
(HealthDay)—Patients who survive the first month after an ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) have

Antimineralocorticoids offer no benefit in heart attack patients without heart failure

August 30, 2015
Heart attack patients without heart failure derive no benefit from the addition of mineralocortoid receptor antagonists (MRA), to standard therapy, results of the ALBATROSS study show.

Nitric oxide inhalation in heart attack patients sends mixed messages, but may offer benefit

September 1, 2014
Inhaled nitric oxide, delivered to heart attack patients before and during treatment with percutaneous coronary intervention (PCI) did not reduce the extent of damaged tissue (infarct), but may have improved recovery, according ...

Metformin does not improve heart function in patients without diabetes

March 31, 2014
Although some research has suggested that metformin, a medication often used in the treatment of diabetes, may have favorable effects on ventricular (heart) function, among patients without diabetes who underwent percutaneous ...

White blood cell count predicts infarct size in STEMI

December 19, 2013
(HealthDay)—For patients with anterior wall ST-segment elevated myocardial infarction (STEMI), elevated white blood cell count (WBCc) on presentation is associated with increased infarct size, according to a study published ...

In STEMI, hyperglycemia tied to larger myocardial area-at-risk

March 8, 2014
(HealthDay)—For patients with ST-segment elevation myocardial infarction (STEMI), hyperglycemia is associated with larger area-at-risk and infarct size, and the effect of exenatide treatment is independent of glucose levels, ...

Recommended for you

No sweat required: Team finds hypertension treatment that mimics effect of exercise

October 16, 2018
Couch potatoes rejoice—there might be a way to get the blood pressure lowering benefits of exercise in pill form.

New model suggests cuffless, non-invasive blood pressure monitoring possible using pulse waves

October 16, 2018
A large team of researchers from several institutions in China and the U.S. has developed a model that suggests it should be possible to create a cuffless, non-invasive blood pressure monitor based on measuring pulse waves. ...

Why heart contractions are weaker in those with hypertrophic cardiomyopathy

October 16, 2018
When a young athlete suddenly dies of a heart attack, chances are high that they suffer from familial hypertrophic cardiomyopathy (HCM). Itis the most common genetic heart disease in the US and affects an estimated 1 in 500 ...

Novel genetic study sheds new light on risk of heart attack

October 12, 2018
Loss of a protein that regulates mitochondrial function can greatly increase the risk of myocardial infarction (heart attack), Vanderbilt scientists reported Oct. 3 in the journal eLife.

Researchers say ritual for orthodox Jewish men may offer heart benefits

October 11, 2018
A pilot study led by researchers at the University of Cincinnati (UC) College of Medicine suggests Jewish men who practice wearing tefillin, which involves the tight wrapping of an arm with leather banding as part of daily ...

Markers of dairy fat consumption linked to lower risk of type two diabetes

October 10, 2018
Higher levels of biomarkers of dairy fat consumption are associated with a lower risk of developing type 2 diabetes, according to new research published today in PLOS Medicine. The study, in more than 60,000 adults, was undertaken ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.