Effects of liraglutide on no-reflow in patients with acute ST-segment elevation myocardial infarction
Introduction
Acute ST-segment elevation myocardial infarction (STEMI) is a major cause of mortality and morbidity. Percutaneous coronary intervention (PCI) is currently the most effective treatment strategy for STEMI [1]. However, myocardial reperfusion is suboptimal in many patients, mostly because of the ‘no-reflow’ phenomenon. To date, however, very few drugs have been shown to reverse established no-reflow [2], [3].
Elevation of blood glucose is a common metabolic disorder among patients with acute myocardial infarction (AMI) and is associated with adverse prognosis [4]. Our previous study found that plasma glucose on admission (APG) was associated with the development of no-reflow in STEMI patients [5]. The no-reflow incidence was increased as APG increased (14.6% in patients with APG < 7.8 mmol/L and 36.7% in patients with APG > 13.0 mmol/L P = 0.009) [6]. Glucagon-like peptide-1 (GLP-1) is an incretin hormone that regulates plasma glucose, and GLP-1 has antioxidant and anti-inflammatory properties, and may protect endothelial function [7], [8], [9]. Experimental studies have also revealed that GLP-1 or its analogs protect against reperfusion injury in pigs [10]. To date, however, there is no clinical evidence for the effects of the GLP-1 analog liraglutide on no-reflow in patients with STEMI. Therefore, the aim of this study was to evaluate the effects of liraglutide pretreatment on myocardial no-reflow of PCI in patients with STEMI.
Section snippets
Study site and ethics
This was a single-centre, prospective, interventional study conducted at the Chinese PLA General Hospital in Beijing, China. The study was approved by the Beijing Ethics Association and the Ethics Committee of the Chinese PLA General Hospital, and complied with the Helsinki Declaration. All of the subjects provided written informed consent to participate in the study. The trial was registered on ClinicalTrials.gov (registration number: NCT02507128).
Study population
The study population comprised 284 patients
Patients
A total of 284 patients with STEMI were enrolled in this study. Of these, 210 patients were randomized 1:1 to receive either liraglutide or placebo. Three patients were excluded and five withdrew during the follow-up in the liraglutide group, while two were excluded and four withdrew in the control group, corresponding to an overall discontinuation rate of 7%. Therefore, 196 patients completed the trial (Fig. 1). The clinical characteristics of the two groups are shown in Table 1. There were no
Discussion
The present study suggests that administration of liraglutide reduced the prevalence of no-reflow in patients with STEMI. In addition, liraglutide elicited favorable changes in markers of inflammation and endothelial function. Thus, our results indicate that liraglutide could reduce myocardial no-reflow and reperfusion injury after PCI for STEMI compared with conventional medicine therapy. To our knowledge, this is the study to demonstrate that liraglutide could prevent no-reflow in STEMI
Conclusions
Liraglutide may be associated with less no-reflow in STEMI, which should be confirmed by larger-scale trials.
Contributors
All authors have substantially contributed to the manuscript in terms of conception and design, analysis and interpretation of data, drafting the article, revising it critically for important intellectual content, and final approval of the version.
Funding
This study was supported by the National Natural Science Foundation of China (fund number 81,441,008).
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, or publication of this article.
Acknowledgments
We express our sincere appreciation to all participants in this study. We also thank Ping Jian Guo, Hang Yu, and Chang Fu Liu, who assisted in this study.
References (44)
- et al.
Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials
Lancet
(2003) - et al.
Exenatide reduces infarct size and improves cardiac function in a porcine model of ischemia and reperfusion injury
J. Am. Coll. Cardiol.
(2009) - et al.
Myocardial no-reflow in humans
J. Am. Coll. Cardiol.
(2009) - et al.
Cardiovascular disease and chronic kidney disease: insights and an update
Am. Heart J.
(2004) - et al.
Interpretation of the thiobarbituric acid reactivity of rat liver and brain homogenates in the presence of ferric ion and ethylediaminotetraacetic acid
Anal. Biochem.
(1992) - et al.
Effects of glycoprotein IIb/IIIa inhibition on microvascular flow after coronary reperfusion
J. Am. Coll. Cardiol.
(2004) - et al.
Beneficial effect of intracoronary verapamil on microvascular and myocardial salvage in patients with acute myocardial infarction
J. Am. Coll. Cardiol.
(1997) - et al.
Intravenous nicorandil can preserve microvascular integrity and myocardial viability in patients with reperfused anterior wall myocardial infarction
J. Am. Coll. Cardiol.
(1999) - et al.
Effects of liraglutide on left ventricular function in patients with non-ST-segment elevation myocardial infarction
Endocrine
(2015) - et al.
Microvascular obstruction: underlying pathophysiology and clinical diagnosis
J. Am. Coll. Cardiol.
(2010)
Effects of liraglutide on left ventricular function in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention
Am. Heart J.
Glucagon-like peptide-relaxes rat con-duit arteries via an endothelium-independent mechanism
Regul. Pept.
Myocardial no-reflow treatment
Curr. Vasc. Pharmacol.
Myocardial ‘no-reflow’ prevention
Curr. Vasc. Pharmacol.
Fasting glucose in acute myocardial infarction: incremental value for long-term mortality and relationship with left ventricular systolic function
Diabetes Care
Development and validation of clinical risk score predicting the no-reflow phenomenon inpatients treated with primary percutaneous coronary intervention for ST-segment elevation myocardial infarction
Cardiology
The effect of admission hyperglycemia on coronary reflow in primary percutaneous coronary intervention
Zhonghua Nei Ke Za Zhi
Exenatide reduces reperfusion injury in patients with ST-segment elevation myocardial infarction
Eur. Heart J.
GLP-1R agonist liraglutide activates cytoprotective pathways and improves outcomes after experimental myocardial infarction in mice
Diabetes
Glucagon-like peptide 1 reduces endothelial dysfunction, inflammation, and oxidative stress induced by both hyperglycemia and hypoglycemia in type 1 diabetes
Diabetes Care
The thrombolysis in myocardial infarction (TIMI) trial
N. Engl. J. Med.
Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction: myocardial blush grade. Zwolle Myocardial Infarction Study Group
Circulation
Cited by (0)
- 1
These authors contributed equally to this work.