Two pilot studies of interleukin-1 (IL-1) blockade in ST-segment elevation myocardial
infarction (STEMI) showed blunted acute inflammatory response and overall favorable
outcomes at 3 months follow-up. We hereby present a patient-level pooled analysis
with extended follow-up of 40 patients with clinically stable STEMI randomized to
anakinra, a recombinant IL-1 receptor antagonist, 100 mg/day for 14 days or placebo
in a double-blinded fashion. End points included death, cardiac death, recurrent acute
myocardial infarction (AMI), stroke, unstable angina, and symptomatic heart failure.
Median follow-up was 28 (interquartile range 3 to 38) months. Sixteen patients (40%)
had a total of 22 adverse cardiovascular events: 1 cardiac death, 4 recurrent AMI,
5 episodes of unstable angina pectoris requiring hospitalization and/or urgent revascularization,
and 11 new diagnoses of heart failure. Treatment with anakinra was associated with
a hazard ratio of 1.08 (95% confidence interval 0.31 to 3.74, p = 0.90) for the combined
end point of death, recurrent AMI, unstable angina pectoris, or stroke and a hazard
ratio of 0.16 (95% confidence interval 0.03 to 0.76, p = 0.008) for death or heart
failure. In conclusion, IL-1 blockade with anakinra for 2 weeks appears, therefore,
to have a neutral effect on recurrent ischemic events, whereas it may prevent new-onset
heart failure long term after STEMI.
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Article info
Publication history
Published online: November 13, 2014
Accepted:
November 3,
2014
Received in revised form:
November 3,
2014
Received:
October 4,
2014
Footnotes
This study was funded by an American Heart Association Scientist Development grant 10SDG 3030051 and a Presidential Research Incentive Program of the Virginia Commonwealth University to Dr. Abbate and by the internal funds of the VCU Pauley Heart Center and Victoria Johnson Research Laboratories (all located in Richmond, VA, USA). Dr. Van Tassell was supported by an Institutional National Institute of Health K12 award KL2RR031989.
Clinical trials registration: www.clinicaltrials.gov (NCT00789724 and NCT01175018).
See page 291 for disclosure information.
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