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Previous Volume 359:473-481 July 31, 2008 Number 5 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Editorial by Hausenloy, D. J. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Experimental evidence suggests that cyclosporine, which inhibits the opening of mitochondrial permeability-transition pores, attenuates lethal myocardial injury that occurs at the time of reperfusion. In this pilot trial, we sought to determine whether the administration of cyclosporine at the time of percutaneous coronary intervention (PCI) would limit the size of the infarct during acute myocardial infarction.

Methods We randomly assigned 58 patients who presented with acute ST-elevation myocardial infarction to receive either an intravenous bolus of 2.5 mg of cyclosporine per kilogram of body weight (cyclosporine group) or normal saline (control group) immediately before undergoing PCI. Infarct size was assessed in all patients by measuring the release of creatine kinase and troponin I and in a subgroup of 27 patients by performing magnetic resonance imaging (MRI) on day 5 after infarction.

Results The cyclosporine and control groups were similar with respect to ischemia time, the size of the area at risk, and the ejection fraction before PCI. The release of creatine kinase was significantly reduced in the cyclosporine group as compared with the control group (P=0.04). The release of troponin I was not significantly reduced (P=0.15). On day 5, the absolute mass of the area of hyperenhancement (i.e., infarcted tissue) on MRI was significantly reduced in the cyclosporine group as compared with the control group, with a median of 37 g (interquartile range, 21 to 51) versus 46 g (interquartile range, 20 to 65; P=0.04). No adverse effects of cyclosporine administration were detected.

Conclusions In our small, pilot trial, administration of cyclosporine at the time of reperfusion was associated with a smaller infarct by some measures than that seen with placebo. These data are preliminary and require confirmation in a larger clinical trial.

Source Information

From Hôpital Arnaud de Villeneuve, Montpellier (C.P., T.T.C., C.M., F.R., C.S., G.G.); Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon (P.C., P.S., H.T., G.R., N.M., E.B., D.A., G.F., X.A.-F., D.R., G.K., G.D., M.O.); Service de Cardiologie, Mulhouse (R.E., J.-P.M.); and INSERM Unité 886, Lyon (H.T., G.R., D.A., G.F., G.D., M.O.) — all in France.

Address reprint requests to Dr. Ovize at Hôpital L. Pradel, Hospices Civils de Lyon, 59, Blvd. Pinel, 69394 Lyon CEDEX 03, France, or at ovize{at}sante.univ-lyon1.fr.

Full Text of this Article

Related Letters:

Cyclosporine in Acute Myocardial Infarction
Theruvath T. P., Lemasters J. J., Rossi J. S., Simpson R. J. Jr., Hoffman I., Ibanez B., Badimon J. J., Ryding A. D., Piot C., Bonnefoy-Cudraz E., Ovize M.
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N Engl J Med 2008; 359:2286-2289, Nov 20, 2008. Correspondence

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