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2014 ; 35
(19
): 1255-62
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Intravenous sodium nitrite in acute ST-elevation myocardial infarction: a
randomized controlled trial (NIAMI)
#MMPMID24639423
Siddiqi N
; Neil C
; Bruce M
; MacLennan G
; Cotton S
; Papadopoulou S
; Feelisch M
; Bunce N
; Lim PO
; Hildick-Smith D
; Horowitz J
; Madhani M
; Boon N
; Dawson D
; Kaski JC
; Frenneaux M
Eur Heart J
2014[May]; 35
(19
): 1255-62
PMID24639423
show ga
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 ?mol 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.