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Pharmacologic Prevention of Myocardial Ischemia-Reperfusion Injury in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. J Cardiovasc Pharmacol 2021; 77:430-449. [PMID: 33416260 DOI: 10.1097/fjc.0000000000000980] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
ABSTRACT Establishing efficient perfusion into the myocardium is the main purpose in patients with acute coronary syndrome, but the process of reperfusion is not without risk and can damage the myocardium paradoxically. Unfortunately, there is no effective treatment for reperfusion injury, and efforts to find an efficient preventive approach are still ongoing. In the past 3 decades, there have been many successful animal studies on how to prevent reperfusion injury; nonetheless, translation to the clinical setting has almost always proven disappointing. In this article, we review clinical studies on the prevention of reperfusion injury in patients with acute coronary syndrome undergoing primary percutaneous coronary intervention in a pharmacologic-based approach. We categorize all the agents that are evaluated for the prevention of myocardial reperfusion injury based on their mechanisms of action into 5 groups: drugs that can reduce oxidative stress, drugs that can affect cellular metabolism, rheological agents that target microvascular obstruction, anti-inflammatory agents, and agents with mixed mechanisms of action. Then, review all the clinical studies of these agents in the setting of primary percutaneous coronary intervention. Finally, we will discuss the possible reasons for the failure in translation of studies into practice and propose potential solutions to overcome this problem.
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Kimura K, Nakao K, Shibata Y, Sone T, Takayama T, Fukuzawa S, Nakama Y, Hirayama H, Matsumoto N, Kosuge M, Hiro T, Sakuma H, Ishihara M, Asakura M, Hamada C, Kaneko A, Yokoi T, Hirayama A. Randomized controlled trial of TY-51924, a novel hydrophilic NHE inhibitor, in acute myocardial infarction. J Cardiol 2015; 67:307-13. [PMID: 26359711 DOI: 10.1016/j.jjcc.2015.07.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/22/2015] [Accepted: 07/27/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND In patients with ST-elevation acute myocardial infarction (STEMI), reperfusion therapy limits infarct size, but can directly evoke myocardial reperfusion injury. Activation of the Na(+)/H(+) exchanger (NHE) plays an important role in reperfusion injury. TY-51924, a novel NHE inhibitor, significantly reduced infarct size in animal studies and was well tolerated in early-phase clinical trials. This study aim was to evaluate the efficacy and safety of TY-51924 in patients with STEMI. METHODS In this multicenter, randomized, double-blind, placebo-controlled Phase II trial, 105 patients with first anterior STEMI undergoing primary percutaneous coronary intervention (pPCI) were randomly assigned to receive an intravenous infusion of either TY-51924 or placebo. Primary endpoints were myocardial salvage index (MSI) as determined by single photon emission computed tomography (SPECT) 3-5 days after pPCI and safety up to 7 days. RESULTS Baseline characteristics were similar in the two groups. MSI 3-5 days after pPCI (0.200 vs. 0.290, p=0.56), 3 months after pPCI (0.470 vs. 0.500, p=0.76), and the incidences of side effects did not differ between the two groups as a whole. However, on post hoc analysis of 52 patients with a large area at risk (AAR) (≥38%) and no antegrade coronary flow, MSI by SPECT at 3 months after pPCI was significantly higher in TY-51924 group (0.450 vs. 0.320, p=0.03). TY-51924 did not adversely influence hemodynamics. CONCLUSIONS TY-51924 did not improve MSI or increase side effects as a whole. However, TY-51924 is potentially cardioprotective in the presence of a large AAR and no antegrade coronary flow.
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Affiliation(s)
- Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | | | - Takahito Sone
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Tadateru Takayama
- Department of Cardiology, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Shigeru Fukuzawa
- Division of Cardiology, Funabashi Municipal Medical Center Heart and Vascular Institute, Funabashi, Japan
| | - Yasuharu Nakama
- Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan
| | - Haruo Hirayama
- Department of Cardiology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Naoya Matsumoto
- Department of Cardiology, Nihon University Hospital, Tokyo, Japan
| | - Masami Kosuge
- Department of Cardiology, Yokohama Ekisaikai Hospital, Yokohama, Japan
| | - Takafumi Hiro
- Division of Advanced Cardiovascular Image Analysis, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masaharu Ishihara
- Division of Coronary Artery Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masanori Asakura
- Department of Clinical Research, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Chikuma Hamada
- Faculty of Engineering, Tokyo University of Science, Tokyo, Japan
| | - Akira Kaneko
- Research & Development Department, TOA EIYO Ltd., Saitama, Japan
| | - Toshiaki Yokoi
- Research & Development Department, TOA EIYO Ltd., Saitama, Japan
| | - Atsushi Hirayama
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
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