Melatonin, an endogenously produced hormone, might potentially limit the ischemia
reperfusion injury and improve the efficacy of mechanical reperfusion with primary
percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction
(STEMI). This study was aimed to evaluate whether the treatment effect of melatonin
therapy in patients with STEMI is influenced by the time to administration. We performed
a post hoc analysis of the Melatonin Adjunct in the Acute Myocardial Infarction Treated
With Angioplasty trial (NCT00640094), which randomized STEMI patients to melatonin
(intravenous and intracoronary bolus) or placebo during pPCI. Randomized patients
were divided into tertiles according to symptoms onset to balloon time: first tertile
(136 ± 23 minutes), second tertile (196 ± 19 minutes), and third tertile (249 ± 41 minutes).
Magnetic resonance imaging was performed within 1 week after pPCI. A total of 146
patients presenting with STEMI within 360 minutes of chest pain onset were randomly
allocated to intravenous and intracoronary melatonin or placebo during pPCI. In the
first tertile, the infarct size was significantly smaller in the melatonin-treated
subjects compared with placebo (14.6 ± 14.2 vs 24.9 ± 9.0%; p = 0.003). Contrariwise,
treatment with melatonin was associated with a larger infarct size in the group of
patients included in the third tertile (20.5 ± 8.7% vs 11.2 ± 5.2%; p = 0.001), resulting
in a significant interaction (p = 0.001). In conclusion, the administration of melatonin
in patients with STEMI who presented early after symptom onset was associated with
a significant reduction in the infarct size after pPCI.
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Article Info
Publication History
Published online: May 29, 2017
Accepted:
May 17,
2017
Received in revised form:
May 17,
2017
Received:
April 5,
2017
Footnotes
This research was funded by the Institute Carlos III (ISCIII), Madrid, Spain ( PI15 / 01260 ), General Branch Evaluation and Research Promotion, State Plan of Scientific and Technical Research and Innovation 2013-2016, and European Regional Development Fund Health (FEDER).
See page 525 for disclosure information.
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© 2017 Elsevier Inc. All rights reserved.
