Usefulness of Early Treatment With Melatonin to Reduce Infarct Size in Patients With ST-Segment Elevation Myocardial Infarction Receiving Percutaneous Coronary Intervention (From the Melatonin Adjunct in the Acute Myocardial Infarction Treated With Angioplasty Trial)

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 wheth...

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Bibliographic Details
Published in:The American journal of cardiology 2017-08, Vol.120 (4), p.522-526
Main Authors: Dominguez-Rodriguez, Alberto, MD, PhD, Abreu-Gonzalez, Pedro, PhD, de la Torre-Hernandez, Jose M., MD, PhD, Consuegra-Sanchez, Luciano, MD, PhD, Piccolo, Raffaele, MD, Gonzalez-Gonzalez, Julia, MD, Garcia-Camarero, Tamara, MD, del Mar Garcia-Saiz, Maria, MD, PhD, Aldea-Perona, Ana, MD, PhD, Reiter, Russel J., PhD
Format: Article
Language:English
Subjects:
Angioplasty
Angioplasty, Balloon, Coronary - methods
Antioxidants - administration & dosage
Cardiovascular
Cardiovascular disease
Coronary vessels
Dose-Response Relationship, Drug
Double-Blind Method
Drug delivery systems
Electrocardiography
Enzyme-Linked Immunosorbent Assay
Female
Follow-Up Studies
Heart attacks
Heart failure
Humans
Injections, Intra-Arterial
Injections, Intravenous
Injury prevention
Intervention
Intravenous administration
Ischemia
Magnetic resonance imaging
Magnetic Resonance Imaging, Cine - methods
Male
Melatonin
Melatonin - administration & dosage
Middle Aged
Myocardial infarction
Myocardium - metabolism
Myocardium - pathology
Pain
Patients
Percutaneous Coronary Intervention
Randomization
Reperfusion
Severity of Illness Index
ST Elevation Myocardial Infarction - diagnosis
ST Elevation Myocardial Infarction - therapy
Studies
Time Factors
Treatment Outcome
Troponin I - metabolism
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Summary: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.
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2017.05.018