Tocilizumab increases myocardial salvage in acute STEMI patients

The interleukin-6 receptor inhibitor tocilizumab improves myocardial salvage in patients with acute ST-segment elevation myocardial infarction (STEMI), results of a recent study have shown.

This randomized, double-blind, placebo-controlled trial was conducted at three high-volume percutaneous coronary intervention (PCI) centres in Norway and included patients admitted with STEMI within 6 hours of symptom onset.

Patients who consented to this trial were randomly assigned in a 1:1 manner to promptly receive a single infusion of tocilizumab 280 mg (n=101) or placebo (n=98). The myocardial salvage index as measured by magnetic resonance imaging after 3 to 7 days was the primary endpoint.

Patients in the tocilizumab arm were found to have larger myocardial salvage index than those in the placebo arm (adjusted between-group difference, 5.6 percentage points, 95 percent confidence interval, 0.2–11.3; p=0.04).

In addition, microvascular obstruction was less extensive in the tocilizumab group, but no significant difference was seen in the final infarct size between the two treatment groups (7.2 percent vs 9.1 percent of myocardial volume; p=0.08). Adverse events were also distributed equally across the tocilizumab and placebo groups.

“Prompt myocardial revascularization with PCI reduces infarct size and improves outcomes in patients with STEMI. However, as much as 50 percent of the loss of viable myocardium may be attributed to the reperfusion injury and the associated inflammatory response,” the investigators said.