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

Intravenous sodium nitrite in acute ST-elevation myocardial infarction: a randomized controlled trial (NIAMI)
Intravenous sodium nitrite in acute ST-elevation myocardial infarction: a randomized controlled trial (NIAMI)
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 doubleblind 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.
acute myocardial infarction, cardioprotection, ischaemia-reperfusion injury, nitrite
0195-668X
1255–1262
Siddiqi, Nishat
a1aa4423-bbbe-4203-b428-0e89438a490d
Neil, Christopher
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Bruce, Margaret
d98e081a-401a-48b8-a159-dcb69837f542
Maclennan, Graeme
209593f8-0b7c-44fd-9abc-c1ea575b6c61
Cotton, Seonaidh
294f5ff5-98fc-4330-ab75-2d42f323e3f6
Papadopoulou, Sofia
60ea80c8-6a4a-4f61-925c-46bdfa913416
Feelisch, Martin
8c1b9965-8614-4e85-b2c6-458a2e17eafd
Bunce, Nicholas
c6024e4d-573d-483d-bd0f-d00033951f96
Lim, Pitt O.
8b21d88e-47c4-46a5-9793-f8e47e3c527b
Hildick-Smith, David
ed5133bd-17d3-48ad-8c2a-cfff6666bc7c
Horowitz, John
75aea564-0d68-4885-80f7-f5a06f53ed3d
Madhani, Melanie
63a48cca-67b7-41ae-bc79-0f4a166f0750
Boon, Nicholas
4ce8b832-a896-41bb-bcaa-414a417b6d60
Dawson, Dana
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Kaski, Juan Carlos
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Frenneaux, Michael
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NIAMI investigators
Siddiqi, Nishat
a1aa4423-bbbe-4203-b428-0e89438a490d
Neil, Christopher
913fe448-8cf6-43e2-8369-e80ee71acd5b
Bruce, Margaret
d98e081a-401a-48b8-a159-dcb69837f542
Maclennan, Graeme
209593f8-0b7c-44fd-9abc-c1ea575b6c61
Cotton, Seonaidh
294f5ff5-98fc-4330-ab75-2d42f323e3f6
Papadopoulou, Sofia
60ea80c8-6a4a-4f61-925c-46bdfa913416
Feelisch, Martin
8c1b9965-8614-4e85-b2c6-458a2e17eafd
Bunce, Nicholas
c6024e4d-573d-483d-bd0f-d00033951f96
Lim, Pitt O.
8b21d88e-47c4-46a5-9793-f8e47e3c527b
Hildick-Smith, David
ed5133bd-17d3-48ad-8c2a-cfff6666bc7c
Horowitz, John
75aea564-0d68-4885-80f7-f5a06f53ed3d
Madhani, Melanie
63a48cca-67b7-41ae-bc79-0f4a166f0750
Boon, Nicholas
4ce8b832-a896-41bb-bcaa-414a417b6d60
Dawson, Dana
5fe72d81-1839-4c4b-93c6-d59d496f327e
Kaski, Juan Carlos
c8ed1d6a-3a25-4661-84f7-27e0fe737ac4
Frenneaux, Michael
fddad0f8-14ca-4001-bd9e-a1a4342a594f

NIAMI investigators (2014) Intravenous sodium nitrite in acute ST-elevation myocardial infarction: a randomized controlled trial (NIAMI). European Heart Journal, 35 (19), 1255–1262. (doi:10.1093/eurheartj/ehu096). (PMID:24639423)

Record type: Article

Abstract

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 doubleblind 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.

Text
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More information

Accepted/In Press date: 12 February 2014
e-pub ahead of print date: 17 March 2014
Published date: 14 May 2014
Keywords: acute myocardial infarction, cardioprotection, ischaemia-reperfusion injury, nitrite
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 363236
URI: http://eprints.soton.ac.uk/id/eprint/363236
ISSN: 0195-668X
PURE UUID: 62670821-58af-4add-b0ee-57b9ce6ef0b2
ORCID for Martin Feelisch: ORCID iD orcid.org/0000-0003-2320-1158

Catalogue record

Date deposited: 24 Mar 2014 10:15
Last modified: 18 Feb 2021 17:18

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Contributors

Author: Nishat Siddiqi
Author: Christopher Neil
Author: Margaret Bruce
Author: Graeme Maclennan
Author: Seonaidh Cotton
Author: Sofia Papadopoulou
Author: Martin Feelisch ORCID iD
Author: Nicholas Bunce
Author: Pitt O. Lim
Author: David Hildick-Smith
Author: John Horowitz
Author: Melanie Madhani
Author: Nicholas Boon
Author: Dana Dawson
Author: Juan Carlos Kaski
Author: Michael Frenneaux
Corporate Author: NIAMI investigators

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