LAUSR

ABSTRACT Patients with ST elevation myocardial infarction (STEMI) are at risk of future heart failure (HF), particularly those with anterior STEMI. Interleukin-1 (IL-1) is a key mediator of the inflammatory response, and its blockade has emerged as a potential therapeutic strategy to prevent HF events. The aim of this analysis was to explore the effects of anakinra, an IL-1 receptor antagonist, on HF outcomes based on anterior versus non-anterior location STEMI and to explore whether this effect is mediated through the amelioration of left ventricular systolic function and cardiac remodeling. We pooled data from three early phase randomized clinical trials. The primary endpoint was a composite of all-cause death and new-onset HF at 1 year follow-up. The left anterior descending coronary artery as culprit vessel was used to identify anterior STEMI. We included 139 patients, 47 (34%) with anterior STEMI and 92 (66%) with non-anterior STEMI. Anakinra significantly reduced the combined endpoint of death or new onset HF in patients with anterior STEMI (4 (13%) vs 7 (42%), log-rank p value=0.049) as well as in patients with non-anterior STEMI (3 [6%] vs 9 [24%], log-rank p value= 0.014). We found no significant differences comparing anakinra versus placebo in interval changes in left ventricular ejection fraction (LVEF) and volumes in anterior and non anterior STEMI. In conclusion, anakinra is associated with a reduction of heart failure events in patients with STEMI, irrespective of anterior or non-anterior location, or of changes in LVEF or cardiac remodeling.