Effect of cyclosporine on reperfusion injury in acute myocardial infarction.
BACKGROUND
Experimental evidence suggests that cyclosporine, which inhibits the opening of mitochondrial permeability-transition pores, attenuates lethal myocardial injury that occurs at the time of reperfusion. In this pilot trial, we sought to determine whether the administration of cyclosporine at the time of percutaneous coronary intervention (PCI) would limit the size of the infarct during acute myocardial infarction.


METHODS
We randomly assigned 58 patients who presented with acute ST-elevation myocardial infarction to receive either an intravenous bolus of 2.5 mg of cyclosporine per kilogram of body weight (cyclosporine group) or normal saline (control group) immediately before undergoing PCI. Infarct size was assessed in all patients by measuring the release of creatine kinase and troponin I and in a subgroup of 27 patients by performing magnetic resonance imaging (MRI) on day 5 after infarction.


RESULTS
The cyclosporine and control groups were similar with respect to ischemia time, the size of the area at risk, and the ejection fraction before PCI. The release of creatine kinase was significantly reduced in the cyclosporine group as compared with the control group (P=0.04). The release of troponin I was not significantly reduced (P=0.15). On day 5, the absolute mass of the area of hyperenhancement (i.e., infarcted tissue) on MRI was significantly reduced in the cyclosporine group as compared with the control group, with a median of 37 g (interquartile range, 21 to 51) versus 46 g (interquartile range, 20 to 65; P=0.04). No adverse effects of cyclosporine administration were detected.


CONCLUSIONS
In our small, pilot trial, administration of cyclosporine at the time of reperfusion was associated with a smaller infarct by some measures than that seen with placebo. These data are preliminary and require confirmation in a larger clinical trial.
Piot
Christophe
C
Hôpital Arnaud de Villeneuve, Montpellier, France.
Croisille
Pierre
P
Staat
Patrick
P
Thibault
Hélène
H
Rioufol
Gilles
G
Mewton
Nathan
N
Elbelghiti
Rachid
R
Cung
Thien Tri
TT
Bonnefoy
Eric
E
Angoulvant
Denis
D
Macia
Christophe
C
Raczka
Franck
F
Sportouch
Catherine
C
Gahide
Gerald
G
Finet
Gérard
G
André-Fouët
Xavier
X
Revel
Didier
D
Kirkorian
Gilbert
G
Monassier
Jean-Pierre
JP
Derumeaux
Geneviève
G
Ovize
Michel
M
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D003131:Combined Modality Therapy; D003402:Creatine Kinase / Q000097:blood; D016572:Cyclosporine / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D033681:Mitochondrial Membrane Transport Proteins / Q000037:antagonists & inhibitors*; D000083162:Mitochondrial Permeability Transition Pore; D009203:Myocardial Infarction / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D010865:Pilot Projects; D011292:Premedication; D016037:Single-Blind Method; D019210:Troponin I / Q000097:blood
D015415:Biomarkers; D033681:Mitochondrial Membrane Transport Proteins; D000083162:Mitochondrial Permeability Transition Pore; D019210:Troponin I; D016572:Cyclosporine; D003402:Creatine Kinase