Author + information
- Alberto Dominguez-Rodrigueza,b,
- Pedro Abreu-Gonzaleza,b,
- Jose M. de la Torre-Hernandeza,b,
- Luciano Consuegra-Sancheza,b,
- Raffaele Piccoloa,b,
- Julia Gonzalez-Gonzaleza,b,
- Tamara Garcia-Camareroa,b,
- Maria del Mar Garcia-Saiza,b,
- Ana Aldea-Peronaa,b and
- Russel Reitera,b
Background: Ischemia-reperfusion injury following ST-segment elevation myocardial infarction (STEMI) is an unavoidable consequence of primary percutaneous coronary intervention (pPCI). Oxidative stress plays a major role in the mechanisms of ischemia-reperfusion injury. In view of its antioxidant properties, melatonin, an endogenously-produced hormone, might potentially limit the ischemia-reperfusion injury and improve the efficacy of mechanical reperfusion with pPCI in STEMI setting. This study aimed to evaluate whether the treatment effect of melatonin therapy among patients with STEMI is influenced by the time to administration.
Methods: We performed a post-hoc analysis of the MARIA (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: 1st tertile (136 ± 23 min), 2nd tertile (196 ± 19 min) and 3rd tertile (249 ± 41 min). Magnetic resonance imaging (MRI) was performed in the acute phase (6 ± 2 days) after STEMI.
Results: A total of 146 patients presenting with STEMI within 360 min of chest pain onset were randomly allocated to intravenous and intracoronary melatonin (n=73) or placebo (n=73) during pPCI. MRI in the acute phase was performed in 86% patients. In the first tertile, the infarct size was significantly smaller in the melatonin-treated individuals compared with placebo (14.6 ± 14.2 versus 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 versus 11.2 ± 5.2 %; p = 0.001), resulting in a significant interaction (p= 0.001).
Conclusions: 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. Further studies are required to evaluate whether melatonin improves clinical outcomes among patients receiving pPCI early after symptoms.
Poster Contributions Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Timely Topics in Acute Coronary Syndromes
Abstract Category: 15. Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology
Presentation Number: 1242-162
- 2017 American College of Cardiology Foundation