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A post hoc analysis of long-term prognosis after exenatide treatment in patients with ST-segment elevation myocardial
Kasper Kyhl1, Jacob Lønborg, Niels Vejlstrup
1Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
Insights
Exenatide treatment adjunct to primary percutaneous coronary intervention (PCI) did not improve long-term outcomes for ST-elevation myocardial infarction (STEMI) patients. However, it significantly reduced heart failure admissions.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Primary percutaneous coronary intervention (PCI) is the standard treatment for ST-elevation myocardial infarction (STEMI).
- Adjunctive therapies are explored to improve long-term clinical outcomes after primary PCI.
- Exenatide, a glucagon-like peptide-1 receptor agonist, has been investigated for cardiovascular benefits.
Purpose of the Study:
- To assess the long-term clinical outcome of exenatide as an adjunct to primary PCI in STEMI patients.
- To evaluate the effect of exenatide on the composite of all-cause mortality and heart failure admission.
- To analyze the individual effects of exenatide on mortality and heart failure readmission.
Main Methods:
- Post hoc analysis of 334 patients with first STEMI from a randomized controlled trial.
- Patients received either exenatide or placebo as an adjunct to primary PCI.
- Median follow-up of 5.2 years, assessing a composite endpoint and individual secondary endpoints.
Main Results:
- The primary composite endpoint (all-cause mortality and heart failure admission) did not differ significantly between exenatide and placebo groups (24% vs. 27%, p=0.44).
- Admission for heart failure was significantly lower in the exenatide group (11%) compared to the placebo group (20%) (p=0.042).
- All-cause mortality showed a trend towards being higher in the exenatide group (14% vs. 9%, p=0.20).
Conclusions:
- Exenatide as an adjunct to primary PCI in STEMI patients did not reduce the composite endpoint or all-cause mortality in the long term.
- Exenatide treatment demonstrated a significant reduction in heart failure admissions.
- Further research may be warranted to explore the specific benefits of exenatide in reducing heart failure events post-STEMI.
Aims:
We aimed to assess the effect of exenatide treatment as an adjunct to primary percutaneous coronary intervention (PCI) on long-term clinical outcome.
Methods And Results:
We performed a post hoc analysis in 334 patients with a first STEMI included in a previous study randomised to exenatide (n=175) or placebo (n=159) as an adjunct to primary PCI. The primary endpoint was a composite of all-cause mortality and admission for heart failure during a median follow-up of 5.2 years (interquartile range: 5.0-5.5). Secondary endpoints were all-cause mortality and admission for heart failure, individually. The primary composite endpoint occurred in 24% in the exenatide group versus 27% in the placebo group, p=0.44 (HR 0.80, p=0.35). Admission for heart failure was lower in the exenatide (11%) compared to the placebo group (20%) (HR 0.53, p=0.042). All-cause mortality occurred in 14% in the exenatide group versus 9% in the placebo group (HR 1.45, p=0.20).
Conclusions:
In this post hoc analysis of patients with a STEMI, treatment with exenatide at the time of primary PCI did not reduce the primary composite endpoint or the secondary endpoint of all-cause -mortality. However, exenatide treatment reduced the incidence of admission for heart failure.
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