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Intravenous sodium nitrite in acute ST-elevation myocardial infarction: a randomized controlled trial (NIAMI).

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journal contribution
posted on 2018-02-21, 12:08 authored by Nishat Siddiqi, Christopher Neil, Margaret Bruce, Graeme MacLennan, Seonaidh Cotton, Sofia Papadopoulou, Martin Feelisch, Nicholas Bunce, Pitt O. Lim, David Hildick-Smith, John Horowitz, Melanie Madhani, Nicholas Boon, Dana Dawson, Juan Carlos Kaski, Michael Frenneaux, NIAMI investigators
AIM: Despite prompt revascularization of acute myocardial infarction (AMI), substantial myocardial injury may occur, in part a consequence of ischaemia reperfusion injury (IRI). There has been considerable interest in therapies that may reduce IRI. In experimental models of AMI, sodium nitrite substantially reduces IRI. In this double-blind randomized placebo controlled parallel-group trial, we investigated the effects of sodium nitrite administered immediately prior to reperfusion in patients with acute ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS: A total of 229 patients presenting with acute STEMI were randomized to receive either an i.v. infusion of 70 μmol sodium nitrite (n = 118) or matching placebo (n = 111) over 5 min immediately before primary percutaneous intervention (PPCI). Patients underwent cardiac magnetic resonance imaging (CMR) at 6-8 days and at 6 months and serial blood sampling was performed over 72 h for the measurement of plasma creatine kinase (CK) and Troponin I. Myocardial infarct size (extent of late gadolinium enhancement at 6-8 days by CMR-the primary endpoint) did not differ between nitrite and placebo groups after adjustment for area at risk, diabetes status, and centre (effect size -0.7% 95% CI: -2.2%, +0.7%; P = 0.34). There were no significant differences in any of the secondary endpoints, including plasma troponin I and CK area under the curve, left ventricular volumes (LV), and ejection fraction (EF) measured at 6-8 days and at 6 months and final infarct size (FIS) measured at 6 months. CONCLUSIONS: Sodium nitrite administered intravenously immediately prior to reperfusion in patients with acute STEMI does not reduce infarct size.

Funding

This study was funded by the UK Medical Research Council. Funding to pay the Open Access publication charges for this article was provided by the University of Aberdeen.

History

Citation

European Heart Journal, 2014, 35 (19), pp. 1255-1262

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Cardiovascular Sciences

Version

  • VoR (Version of Record)

Published in

European Heart Journal

Publisher

Oxford University Press (OUP) for European Society of Cardiology

issn

0195-668X

eissn

1522-9645

Acceptance date

2014-02-12

Copyright date

2014

Available date

2018-02-21

Publisher version

https://academic.oup.com/eurheartj/article/35/19/1255/2293060

Notes

Supplementary material is available at European Heart Journal online.

Language

en