Interleukin-1 blockade in patients with ST-segment elevation myocardial infarction with and without history of coronary artery disease

Background

Patients with a history of coronary artery disease (CAD) presenting with ST-elevation myocardial infarction (STEMI) have high risk. We aimed to determine whether patients with CAD history presenting with STEMI had greater systemic inflammation and/or whether they benefitted similarly from IL-1 blockade.

Methods

We pooled data from three randomized clinical trials, including 139 patients with STEMI treated with anakinra or placebo. Patients were stratified by history of CAD defined as prior documented CAD, MI or coronary revascularization. The area under the curve (AUC) for C-reactive protein (CRP) was used to assess systemic inflammation. Event-free survival defined as the time from enrollment to the occurrence of a predefined adverse outcome, including new-onset heart failure, hospitalization for heart failure, or death, was compared using Cox regression analysis.

Results

Of the 139 patients, 113 (81 %) had no history of CAD, while 26 (19 %) had a history of CAD. The CRP-AUC was significantly lower in the anakinra group compared placebo, independent of history of CAD: 85 [47–137] vs. 349 [154–580] mg·day/L for anakinra and placebo, respectively, in patients with history of CAD, and 86 [43–179] vs. 213 [115–341] mg·day/L in patients without CAD history; p for interaction = (0.27). No significant interactions were found between history of CAD and treatment allocation for the composite outcome for patients with and without history of CAD, respectively, p for interaction = (0.48).

Conclusion

IL-1 blockade with anakinra in STEMI leads to similar reductions in systemic inflammation and improvement in HF-related outcomes inpatients both with and without history of CAD.