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

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Authors

  • 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

Colleges, School and Institutes

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 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.

Details

Original languageEnglish
Pages (from-to)1255-62
Number of pages8
JournalEuropean Heart Journal
Volume35
Issue number19
Early online date17 Mar 2014
Publication statusPublished - 14 May 2014

Keywords

  • Biomarkers, Cardiotonic Agents, Double-Blind Method, Female, Humans, Infusions, Intravenous, Male, Middle Aged, Myocardial Infarction, Myocardial Reperfusion, Myocardial Reperfusion Injury, Percutaneous Coronary Intervention, Sodium Nitrite, Treatment Outcome