Abstract 13656: Improvement in Left Ventricular Performance With Anakinra in St-Segment Elevation Myocardial Infarction

BackgroundInterleukin-1 (IL-1), a central mediator of the post-infarction inflammatory response, decreases left ventricular systolic function in preclinical models of myocardial infarction. However, the effect of IL-1 blockade on left ventricular (LV) performance in patients after STEMI is unknown.HypothesisWe hypothesized that IL-1 blockade with anakinra, a human recombinant IL-1 receptor antagonist, improves LV performance in ST-segment Elevation Myocardial Infarction (STEMI) patients.MethodsPatients with STEMI who underwent urgent coronary angiography within 12 hours of symptoms were enrolled and were randomized in 1:1:1 ratio to 100 mg once daily (low dose), 100 mg twice daily (high dose), or placebo for 14 days. All subjects underwent a transthoracic Doppler echocardiogram within 24 hours of study enrollment and again at 1-year follow up. Data from the anakinra groups were pooled. Paired data on LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), stroke volume (SV), stroke work (SW) and LV ejection fraction (LVEF) were available for 63 patients, 23 in the placebo group and 40 in the anakinra combined group.ResultsAt baseline, LVEDV, LVESV, SV, SW and LVEF, as well as clinical and laboratory data were not significantly different between placebo and anakinra group (all P>0.05). When compared with placebo, anakinra treated patients had a significant improvement in SV (P=0.027), and SW (P=0.004). Patients treated with anakinra also had a significant within-group improvement in LVEF (P=0.007) (Figure), however without significant between-group differences compared to placebo. No significant changes were noted in LVEDV and LVESV in either group.ConclusionTreatment with anakinra for 14 days after STEMI significantly improved LV performance at 1-year in patients with STEMI, possibly due to the relief of the negative inotropic effects of IL-1 on the myocardium.