Cardioprotective Effects of Exenatide in Patients With ST-Segment–Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: Results of Exenatide Myocardial Protection in Revascularization Study

• Published in: Arteriosclerosis, thrombosis, and vascular biology Vol. 33; no. 9; pp. 2252 - 2260
• Main Authors: Woo, Jong Shin, Kim, Weon, Ha, Sang Jin, Kim, Jin Bae, Kim, Soo-Joong, Kim, Woo-Shik, Seon, Hyun Ju, Kim, Kwon Sam
• Format: Journal Article
• Language: English
• Published: United States American Heart Association, Inc 01.09.2013
• Subjects: Aged; Biomarkers - blood; Cardiotonic Agents - administration & dosage; Cardiotonic Agents - adverse effects; Cardiotonic Agents - therapeutic use; Chi-Square Distribution; Creatine Kinase, MB Form - blood; Drug Administration Schedule; Echocardiography, Doppler; Female; Humans; Hypoglycemic Agents - administration & dosage; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - therapeutic use; Injections, Subcutaneous; Magnetic Resonance Imaging; Male; Middle Aged; Myocardial Contraction - drug effects; Myocardial Infarction - blood; Myocardial Infarction - pathology; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Myocardium - enzymology; Myocardium - pathology; Peptides - administration & dosage; Peptides - adverse effects; Peptides - therapeutic use; Percutaneous Coronary Intervention - adverse effects; Predictive Value of Tests; Proportional Hazards Models; Prospective Studies; Republic of Korea; Stroke Volume - drug effects; Time Factors; Treatment Outcome; Troponin I - blood; Venoms - administration & dosage; Venoms - adverse effects; Venoms - therapeutic use; Ventricular Function, Left - drug effects; Republic of Korea; magnetic resonance imaging; percutaneous coronary intervention; reperfusion injury; myocardial infarction; exenatide
• ISSN: 1079-5642; 1524-4636
• DOI: 10.1161/ATVBAHA.113.301586

OBJECTIVE—Experimental evidence suggests that exenatide, a glucagon-like peptide 1 receptor analogue, has significant cardiovascular protective effects in various conditions. We examined whether routine use of exenatide at the time of primary percutaneous coronary intervention would reduce infarct size in patients with ST-segment–elevation myocardial infarction. APPROACH AND RESULTS—Fifty-eight patients with ST-segment–elevation myocardial infarction and thrombolysis in myocardial infarction flow 0 were enrolled in the study and randomly assigned to receive either exenatide or placebo (saline) subcutaneously. Infarct size was assessed by measuring the release of creatine kinase-MB and troponin I during 72 hours and by performing cardiac magnetic resonance imaging at 1 month after infarction. Routine and speckle tracking echocardiography was performed at initial presentation and at 3 days and 6 months after primary percutaneous coronary intervention. The exenatide and control groups had similar results with respect to ischemia time, demographic characteristics, and ejection fraction before primary percutaneous coronary intervention. The releases of creatine kinase-MB and troponin I were significantly reduced in the exenatide group. In 58 patients evaluated with cardiac magnetic resonance, the absolute mass of delayed hyperenhancement was significantly reduced in the exenatide group as compared with the control group (12.8±11.7 versus 26.4±11.6 g; P<0.01). At 6 months, the exenatide group showed a significantly lower value of E/E′ with improved strain parameters. No significant adverse effects of exenatide administration were detected. CONCLUSIONS—In patients with ST-segment–elevation myocardial infarction, adjunctive exenatide therapy with primary percutaneous coronary intervention was associated with reduction of infarct size and improvement of subclinical left ventricular function.