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MYOCARDIAL INFARCTION

Early inhibition of IL-6 signalling after an acute MI improves myocardial salvage

Nature Reviews Cardiology volume 18, page 460 (2021)Cite this article

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The loss of viable myocardium in the setting of ischaemia–reperfusion injury after myocardial infarction (MI) has been linked to the associated inflammatory response. A new randomized clinical trial now shows that tocilizumab, a monoclonal antibody that inhibits IL-6 signalling by binding to the IL-6 receptor, increases myocardial salvage in patients with acute ST-segment elevation MI (STEMI) who undergo revascularization with percutaneous coronary intervention (PCI).

The ASSAIL-MI trial enrolled 199 patients with STEMI who were admitted to three centres in Norway within 6 h of symptom onset. The patients were randomly assigned to receive a single intravenous infusion of 280 mg of tocilizumab or placebo during the PCI. Tocilizumab was associated with an increase in the myocardial salvage index (the primary end point), as measured by cardiac MRI at 3–7 days after PCI, compared with placebo (adjusted between-group difference 5.6 percentage points, P = 0.04). Of note, this effect seemed to be limited to patients with symptom onset >3 h before PCI. Tocilizumab had no significant effect on the final infarct size at 6 months compared with placebo (7.2% versus 9.1% of myocardial volume; P = 0.08) but induced significant reductions in the secondary end points of microvascular obstruction and C-reactive protein levels during the index hospitalization. The number of adverse events was similar in both groups but, as previously described with tocilizumab, this drug was associated with transient increases in LDL and triglyceride levels and a mild decrease in neutrophil and monocyte counts.

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References

Original article

  • Broch, K. et al. Randomized trial of interleukin-6 receptor inhibition in patients with acute ST-segment elevation myocardial infarction. J. Am. Coll. Cardiol. 77, 1845–1855 (2021)

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  1. Nature Reviews Cardiology http://www.nature.com/nrcardio/

    Irene Fernández-Ruiz

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  1. Irene Fernández-Ruiz
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Correspondence to Irene Fernández-Ruiz.

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Fernández-Ruiz, I. Early inhibition of IL-6 signalling after an acute MI improves myocardial salvage. Nat Rev Cardiol 18, 460 (2021). https://doi.org/10.1038/s41569-021-00560-1

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  • DOI: https://doi.org/10.1038/s41569-021-00560-1

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