Effect of Ciclosporin on Safety, Lymphocyte Kinetics and Left Ventricular Remodelling in Acute Myocardial Infarction – DocWire News

PURPOSE:

Following a favourable pilot trial using a single-bolus of ciclosporin, it has been unclear why two large studies (CYCLE and CIRCUS) failed to prevent reperfusion injury and reduce infarct size in STEMI (ST elevationmyocardial infarction). The purpose of this study was to assess the effect of ciclosporin onmyocardialinjury, LV-remodelling, and lymphocyte kinetics in patients with acute STEMI undergoing primary PCI.

In this double-blind, single centre trial, we randomly assigned 52 acute STEMI patients with an onset of pain of less than 6 hours and blocked culprit artery to a single bolus of ciclosporin (n=26) or placebo (n=26, control group) prior to reperfusion by stent PCI. The primary endpoint was infarct size at 12 weeks.

Mean infarct size at 12 weeks was identical in both groups (9.1% (SD=7.0) vs 9.1% (SD=7.0), p=0.99; 95% CI for difference: -4.0 to 4.1). CD3 T-lymphocytes dropped to similar levels at 90 min (867 vs 852 cells/ul, control vs ciclosporin) and increased to 1454 vs 1650 cells/ul at 24h.

In our pilot trial a single ciclosporin bolus did not affect infarct size or LV remodelling, matching the results from CYCLE and CIRCUS. Our study suggests that ciclosporin does either not reach ischaemic cardiomyocytes, or requires earlier application during first medical contact. Finally, one bolus of ciclosporin is not sufficient to inhibit CD4 T-lymphocyte proliferation during remodelling. We therefore believe that further studies are warranted. (Evaluating the effectiveness of intravenous Ciclosporin on reducing reperfusion injury in pAtients undergoing PRImary percutaneous coronary intervention.

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Effect of Ciclosporin on Safety, Lymphocyte Kinetics and Left Ventricular Remodelling in Acute Myocardial Infarction - DocWire News