Giving patients with ST-segment elevation myocardial infarction a cyclosporine bolus at the time of reperfusion appears to reduce infarct size by about 40%, researchers in a small proof-of-concept trial reported.
The study results “support the argument that reperfusion necrosis is a major component of infarct size after prolonged ischemia and reperfusion,” said Dr. Christophe Piot of Hôpital Arnaud de Villeneuve, Montpellier, France, and associates (N. Engl. J. Med. 2008;359:473–81).
Cyclosporine has shown promise in limiting reperfusion injury in preclinical studies. The investigators conducted their prospective, multicenter trial in 58 patients with acute ST-segment elevation MI who were slated for percutaneous coronary intervention. Both the size of the infarct and the size of the area considered to be at risk were estimated by measuring the circumferential extent of abnormally contracting segments on angiography.
After coronary angiography was performed, but before stent placement, the patients were randomly assigned to receive a single IV bolus of either cyclosporine (30 subjects) or normal saline (28 control subjects).
Infarct size after reperfusion, as measured by release of serum creatine kinase, was significantly reduced in the cyclosporine group but not in the control group. The difference “represents a reduction in the infarct size of approximately 40%,” the investigators said.
When the subjects were categorized according to the size of the area at risk, the infarcts that developed in those given cyclosporine were consistently smaller than those that developed in control subjects.
In a subgroup of 27 patients who underwent MRI, the absolute mass of the area of delayed hyperenhancement was 20% smaller in those given cyclosporine than in control subjects.
No adverse events were attributed to cyclosporine.