Usefulness of Early Treatment With Melatonin to Reduce Infarct Size in Patients With ST-Segment Elevation Myocardial Infarction Receiving Percutaneous Coronary Intervention (From the Melatonin Adjunct in the Acute Myocardial Infarction Treated With Angioplasty Trial).
Study Goal
The researchers aimed to evaluate whether the timing of melatonin administration influences its treatment effect in reducing infarct size in STEMI patients undergoing pPCI.
Results Summary
Melatonin significantly reduced infarct size in patients treated early (first tertile) but was associated with larger infarct size in those treated later (third tertile), showing a significant interaction based on timing.
Population
146 patients with STEMI presenting within 360 minutes of chest pain onset.
Effective Dosage
Intravenous and intracoronary bolus (specific amounts not detailed).
Duration
Administered during pPCI (single intervention).
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
melatonin therapy | decrease | ischemia reperfusion injury | patients with STEMI | - | might potentially limit | #1 |
melatonin therapy | increase | efficacy of mechanical reperfusion with primary percutaneous coronary intervention (pPCI) | patients with STEMI | - | might potentially improve | #2 |
melatonin (intravenous and intracoronary bolus) | decrease | infarct size | patients in the first tertile (symptoms onset to balloon time: 136 ± 23 minutes) | 14.6 ± 14.2% vs 24.9 ± 9.0% | infarct size was significantly smaller | #3 |
melatonin (intravenous and intracoronary bolus) | increase | infarct size | patients in the third tertile (symptoms onset to balloon time: 249 ± 41 minutes) | 20.5 ± 8.7% vs 11.2 ± 5.2% | was associated with a larger infarct size | #4 |
melatonin | decrease | infarct size after pPCI | patients with STEMI who presented early after symptom onset | - | was associated with a significant reduction | #5 |
Melatonin, an endogenously produced hormone, might potentially limit the ischemia reperfusion injury and improve the efficacy of mechanical reperfusion with primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction (STEMI). This study was aimed to evaluate whether the treatment effect of melatonin therapy in patients with STEMI is influenced by the time to administration. We performed a post hoc analysis of the Melatonin Adjunct in the Acute Myocardial Infarction Treated With Angioplasty trial (NCT00640094), which randomized STEMI patients to melatonin (intravenous and intracoronary bolus) or placebo during pPCI. Randomized patients were divided into tertiles according to symptoms onset to balloon time: first tertile (136 ± 23 minutes), second tertile (196 ± 19 minutes), and third tertile (249 ± 41 minutes). Magnetic resonance imaging was performed within 1 week after pPCI. A total of 146 patients presenting with STEMI within 360 minutes of chest pain onset were randomly allocated to intravenous and intracoronary melatonin or placebo during pPCI. In the first tertile, the infarct size was significantly smaller in the melatonin-treated subjects compared with placebo (14.6 ± 14.2 vs 24.9 ± 9.0%; p = 0.003). Contrariwise, treatment with melatonin was associated with a larger infarct size in the group of patients included in the third tertile (20.5 ± 8.7% vs 11.2 ± 5.2%; p = 0.001), resulting in a significant interaction (p = 0.001). In conclusion, the administration of melatonin in patients with STEMI who presented early after symptom onset was associated with a significant reduction in the infarct size after pPCI.