| Introduction: Reperfusion injury reduces the benefits of early reperfusion therapies after
acute ST-elevation myocardial infarction (STEMI). Cyclosporine-A (CsA) is a potent inhibitor
of opening of the mitochondrial permeability transition pore, which has been shown to
play a key role in myocardial reperfusion injury. The impact of this treatment on clinical
outcomes of acute STEMI remains unknown. Our aim was to investigate the clinical
outcomes of using this drug in patients with acute anterior STEMI receiving thrombolytic
treatment (TLT). Methods: In this double-blinded randomized clinical trial, 101 patients
with acute anterior STEMI who were candidate for TLT, were enrolled and randomly
assigned into treatment or control groups. Patients in the treatment group received an intravenous
bolus injection of 2.5 mg/kg of CsA immediately before TLT. The patients in the
control group received an equivalent volume of normal saline. Infarct size, occurrence of
major arrhythmias, heart failure, left ventricular ejection fraction (LVEF), TLT-related complications,
in-hospital and 6-month mortality rates were investigated. Results: There were
no significant differences among the demographics, myocardial enzyme release, occurrence
of major arrhythmias [9 (18%) vs. 12 (23.5%), P = 0.80], heart failure [18 (36%) vs. 19
(38.3%), P = 0.83], LVEF at first day [34.7 ± 9.9% vs. 33.5 ± 8.1%, P = 0.50] or at discharge
[37.7 ± 10% vs. 36.1 ± 8.2%, P = 0.43], and in-hospital [4 (8%) vs. 6 (11.8%), P = 0.74] or
6-month mortality rates [9 (18%) vs. 10 (19.6%), P = 0.99] between the CsA vs. the control
group. Conclusion: In this study, the prethrombolytic administration of CsA was not associated
with a reduction in the infarct size or any improvement in clinical outcomes. |