title: Exenatide reduces reperfusion injury in patients with ST-segment elevation myocardial infarction.
abstract: OBJECTIVE
  Exenatide, a glucagon-like-peptide-1 analogue, increases myocardial salvage in experimental settings with coronary occlusion and subsequent reperfusion. We evaluated the cardioprotective effect of exenatide at the time of reperfusion in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI).
  
  
  RESULTS
  A total of 172 patients with STEMI and Thrombolysis in Myocardial Infarction flow 0/1 were randomly assigned to exenatide or placebo (saline) intravenously. Study treatment was commenced 15 min before intervention and maintained for 6 h after the procedure. The primary endpoint was salvage index calculated from myocardial area at risk (AAR), measured in the acute phase, and final infarct size measured 90 ± 21 days after pPCI by cardiac magnetic resonance (CMR). In 105 patients evaluated with CMR, a significantly larger salvage index was found in the exenatide group than in the placebo group (0.71 ± 0.13 vs. 0.62 ± 0.16; P= 0.003). Infarct size in relation to AAR was also smaller in the exenatide group (0.30 ± 0.15 vs. 0.39 ± 0.15; P= 0.003). In a regression analysis, there was a significant correlation between the infarct size and the AAR for both treatment groups and an analysis of covariance showed that datapoints in the exenatide group lay significantly lower than for the placebo group (P= 0.011). There was a trend towards smaller absolute infarct size in the exenatide group (13 ± 9 vs. 17 ± 14 g; P= 0.11). No difference was observed in left ventricular function or 30-day clinical events. No adverse effects of exenatide were observed.
  
  
  CONCLUSIONS
  In patients with STEMI undergoing pPCI, administration of exenatide at the time of reperfusion increases myocardial salvage.
authors.affiliation: Department of Cardiology, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark. jacoblonborg@gmail.com
authors.forename: Jacob
authors.initials: J
authors.lastname: Lønborg
authors.forename: Niels
authors.initials: N
authors.lastname: Vejlstrup
authors.forename: Henning
authors.initials: H
authors.lastname: Kelbæk
authors.forename: Hans Erik
authors.initials: HE
authors.lastname: Bøtker
authors.forename: Won Yong
authors.initials: WY
authors.lastname: Kim
authors.forename: Anders B
authors.initials: AB
authors.lastname: Mathiasen
authors.forename: Erik
authors.initials: E
authors.lastname: Jørgensen
authors.forename: Steffen
authors.initials: S
authors.lastname: Helqvist
authors.forename: Kari
authors.initials: K
authors.lastname: Saunamäki
authors.forename: Peter
authors.initials: P
authors.lastname: Clemmensen
authors.forename: Lene
authors.initials: L
authors.lastname: Holmvang
authors.forename: Leif
authors.initials: L
authors.lastname: Thuesen
authors.forename: Lars Romer
authors.initials: LR
authors.lastname: Krusell
authors.forename: Jan S
authors.initials: JS
authors.lastname: Jensen
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.forename: Marek
authors.initials: M
authors.lastname: Treiman
authors.forename: Jens Juul
authors.initials: JJ
authors.lastname: Holst
authors.forename: Thomas
authors.initials: T
authors.lastname: Engstrøm
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D004311:Double-Blind Method; D000077270:Exenatide; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D010455:Peptides / Q000627:therapeutic use*; D014688:Venoms / Q000627:therapeutic use*
chemical_list: D002316:Cardiotonic Agents; D010455:Peptides; D014688:Venoms; D000077270:Exenatide