title: Exenatide reduces final infarct size in patients with ST-segment-elevation myocardial infarction and short-duration of ischemia.
abstract: BACKGROUND
  Exenatide has been demonstrated to be cardioprotective as an adjunct to primary percutaneous coronary intervention in patients with ST-segment-elevation myocardial infarction (STEMI). The aim of the post hoc analysis study was to evaluate the effect of exenatide in relation to system delay, defined as time from first medical contact to first balloon.
  
  
  RESULTS
  Patients with STEMI and Thrombolysis In Myocardial Infarction flow 0/1 were randomly assigned to intravenous exenatide or placebo continuous infusion. Study treatment was commenced 15 minutes before intervention and maintained for 6 hours after the procedure. The patients were stratified according to median system delay (132 minutes). Final infarct size and myocardial area at risk were measured by cardiovascular magnetic resonance. Among patients with a system delay ≤132 minutes (n=74), treatment with exenatide resulted in a smaller infarct size (9 grams [interquartile range (IQR), 4-13] versus 13 grams [IQR, 8-24], P=0.008, corresponding to 8% [IQR, 4-12] versus 11% [IQR, 7-17] of the left ventricle, P=0.015). In a regression analysis adjusting for myocardial area at risk the data points of the exenatide group lay significantly lower than for the placebo group (P=0.006). In the patients with system delay >132 minutes (n=74) no difference was observed in infarct size expressed as grams (P=0.49) or percentage (P=0.46). There was significant interaction between system delay (less than or equal to median versus greater than median) and treatment allocation in terms of infarct size (P=0.018).
  
  
  CONCLUSIONS
  In this post hoc analysis, exenatide treatment was associated with a 30% decrease in final infarct size in patients with short system delay, whereas no cardioprotective effect in patients with long system delay was seen. However, this finding must be confirmed in larger studies.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00835848.
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen, Denmark. Jacoblonborg@gmail.com
authors.forename: Jacob
authors.initials: J
authors.lastname: Lønborg
authors.forename: Henning
authors.initials: H
authors.lastname: Kelbæk
authors.forename: Niels
authors.initials: N
authors.lastname: Vejlstrup
authors.forename: Hans Erik
authors.initials: HE
authors.lastname: Bøtker
authors.forename: Won Yong
authors.initials: WY
authors.lastname: Kim
authors.forename: Lene
authors.initials: L
authors.lastname: Holmvang
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: Christian Juhl
authors.initials: CJ
authors.lastname: Terkelsen
authors.forename: Mikkel Malby
authors.initials: MM
authors.lastname: Schoos
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.forename: Peter
authors.initials: P
authors.lastname: Clemmensen
authors.forename: Marek
authors.initials: M
authors.lastname: Treiman
authors.forename: Thomas
authors.initials: T
authors.lastname: Engstrøm
mesh_terms: D000368:Aged; D017130:Angioplasty; D017024:Chemotherapy, Adjuvant; D003331:Coronary Vessels / Q000601:surgery; D018572:Disease-Free Survival; D004562:Electrocardiography; D000077270:Exenatide; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D009206:Myocardium / Q000473:pathology*; D010455:Peptides / Q000008:administration & dosage* / Q000009:adverse effects; D011859:Radiography; D015427:Reperfusion Injury / Q000209:etiology / Q000517:prevention & control*; D014688:Venoms / Q000008:administration & dosage* / Q000009:adverse effects; D052096:Warm Ischemia
chemical_list: D007004:Hypoglycemic Agents; D010455:Peptides; D014688:Venoms; D000077270:Exenatide