Document Detail

Human atrial natriuretic peptide and nicorandil as adjuncts to reperfusion treatment for acute myocardial infarction (J-WIND): two randomised trials.
MedLine Citation:
PMID:  17964349     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Patients who have acute myocardial infarction remain at major risk of cardiovascular events. We aimed to assess the effects of either human atrial natriuretic peptide or nicorandil on infarct size and cardiovascular outcome. METHODS: We enrolled 1216 patients who had acute myocardial infarction and were undergoing reperfusion treatment in two prospective, single-blind trials at 65 hospitals in Japan. We randomly assigned 277 patients to receive intravenous atrial natriuretic peptide (0.025 microg/kg per min for 3 days) and 292 the same dose of placebo. 276 patients were assigned to receive intravenous nicorandil (0.067 mg/kg as a bolus, followed by 1.67 microg/kg per min as a 24-h continuous infusion), and 269 the same dose of placebo. Median follow-up was 2.7 (IQR 1.5-3.6) years for patients in the atrial natriuretic peptide trial and 2.5 (1.5-3.7) years for those in the nicorandil trial. Primary endpoints were infarct size (estimated from creatine kinase) and left ventricular ejection fraction (gauged by angiography of the left ventricle). FINDINGS: 43 patients withdrew consent after randomisation, and 59 did not have acute myocardial infarction. We did not assess infarct size in 50 patients for whom we had fewer than six samples of blood. We did not have angiographs of left ventricles in 383 patients. Total creatine kinase was 66,459.9 IU/mL per h in patients given atrial natriuretic peptide, compared with 77,878.9 IU/mL per h in controls, with a ratio of 0.85 between these groups (95% CI 0.75-0.97, p=0.016), which indicated a reduction of 14.7% in infarct size (95% CI 3.0-24.9%). The left ventricular ejection fraction at 6-12 months increased in the atrial natriuretic peptide group (ratio 1.05, 95% CI 1.01-1.10, p=0.024). Total activity of creatine kinase did not differ between patients given nicorandil (70 520.5 IU/mL per h) and controls (70 852.7 IU/mL per h) (ratio 0.995, 95% CI 0.878-1.138, p=0.94). Intravenous nicorandil did not affect the size of the left ventricular ejection fraction, although oral administration of nicorandil during follow-up increased the left ventricular ejection fraction between the chronic and acute phases. 29 patients in the atrial natriuretic peptide group had severe hypotension, compared with one in the corresponding placebo group. INTERPRETATION: Patients with acute myocardial infarction who were given atrial natriuretic peptide had lower infarct size, fewer reperfusion injuries, and better outcomes than controls. We believe that atrial natriuretic peptide could be a safe and effective adjunctive treatment in patients with acute myocardial infarction who receive percutaneous coronary intervention.
Masafumi Kitakaze; Masanori Asakura; Jiyoong Kim; Yasunori Shintani; Hiroshi Asanuma; Toshimitsu Hamasaki; Osamu Seguchi; Masafumi Myoishi; Tetsuo Minamino; Takahiro Ohara; Yoshiyuki Nagai; Shinsuke Nanto; Kouki Watanabe; Shigeru Fukuzawa; Atsushi Hirayama; Natsuki Nakamura; Kazuo Kimura; Kenshi Fujii; Masaharu Ishihara; Yoshihiko Saito; Hitonobu Tomoike; Soichiro Kitamura;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Lancet     Volume:  370     ISSN:  1474-547X     ISO Abbreviation:  Lancet     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-10-29     Completed Date:  2007-11-05     Revised Date:  2008-01-07    
Medline Journal Info:
Nlm Unique ID:  2985213R     Medline TA:  Lancet     Country:  England    
Other Details:
Languages:  eng     Pagination:  1483-93     Citation Subset:  AIM; IM    
Cardiovascular Division of Medicine, National Cardiovascular Centre, Suita, Osaka, Japan.
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MeSH Terms
Atrial Natriuretic Factor / administration & dosage,  therapeutic use*
Creatine Kinase / blood
Infusions, Intravenous
Middle Aged
Myocardial Infarction / drug therapy*,  mortality,  pathology
Nicorandil / administration & dosage,  therapeutic use*
Reperfusion Injury
Vasodilator Agents / administration & dosage,  therapeutic use*
Reg. No./Substance:
0/Vasodilator Agents; 65141-46-0/Nicorandil; 85637-73-6/Atrial Natriuretic Factor; EC Kinase
Comment In:
Lancet. 2007 Oct 27;370(9597):1461-2   [PMID:  17964332 ]
Erratum In:
Lancet. 2008 Dec 22;370(9605):2102

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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