Interleukin-1 blockade in patients with ST-segment elevation myocardial infarction with and without history of coronary artery disease
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Updated: Jan 18, 2026
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Published on: May 28, 2019
Rocio I Lopez1, Matteo Morello2, Michele Golino3
1Robert M. Berne Cardiovascular Research Center and Department of Medicine, University of Virginia, Charlottesville, VA, United States; Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Insights
Patients with coronary artery disease (CAD) history undergoing ST-elevation myocardial infarction (STEMI) treatment benefit similarly from IL-1 blockade. Anakinra effectively reduces systemic inflammation and improves heart failure outcomes in STEMI patients, regardless of CAD history.
Area of Science:
- Cardiology
- Immunology
- Clinical Trials
Background:
- Patients with ST-elevation myocardial infarction (STEMI) and a history of coronary artery disease (CAD) face elevated risks.
- Systemic inflammation is a key factor in STEMI outcomes.
- The efficacy of IL-1 blockade in STEMI patients with prior CAD requires further investigation.
Purpose of the Study:
- To assess systemic inflammation levels in STEMI patients with and without a history of CAD.
- To determine if STEMI patients with a history of CAD benefit equally from IL-1 blockade therapy.
- To evaluate the impact of anakinra on event-free survival in STEMI patients stratified by CAD history.
Main Methods:
- Pooled data from three randomized clinical trials involving 139 STEMI patients treated with anakinra or placebo.
- Stratification of patients based on documented history of CAD (prior MI, revascularization).
- Assessment of systemic inflammation using C-reactive protein (CRP) area under the curve (AUC); event-free survival analyzed via Cox regression.
Main Results:
- Anakinra significantly reduced CRP-AUC compared to placebo, irrespective of CAD history.
- No significant interaction was observed between CAD history and anakinra treatment for the composite adverse outcome.
- Patients with and without CAD history showed similar improvements in event-free survival with anakinra.
Conclusions:
- IL-1 blockade with anakinra effectively reduces systemic inflammation in STEMI patients.
- Anakinra provides similar benefits in reducing heart failure-related outcomes for STEMI patients with or without a history of CAD.
- Treatment with anakinra is a viable option for STEMI patients, irrespective of their coronary artery disease status.
Background:
Patients with a history of coronary artery disease (CAD) presenting with ST-elevation myocardial infarction (STEMI) have high risk. We aimed to determine whether patients with CAD history presenting with STEMI had greater systemic inflammation and/or whether they benefitted similarly from IL-1 blockade.
Methods:
We pooled data from three randomized clinical trials, including 139 patients with STEMI treated with anakinra or placebo. Patients were stratified by history of CAD defined as prior documented CAD, MI or coronary revascularization. The area under the curve (AUC) for C-reactive protein (CRP) was used to assess systemic inflammation. Event-free survival defined as the time from enrollment to the occurrence of a predefined adverse outcome, including new-onset heart failure, hospitalization for heart failure, or death, was compared using Cox regression analysis.
Results:
Of the 139 patients, 113 (81 %) had no history of CAD, while 26 (19 %) had a history of CAD. The CRP-AUC was significantly lower in the anakinra group compared placebo, independent of history of CAD: 85 [47-137] vs. 349 [154-580] mg·day/L for anakinra and placebo, respectively, in patients with history of CAD, and 86 [43-179] vs. 213 [115-341] mg·day/L in patients without CAD history; p for interaction = (0.27). No significant interactions were found between history of CAD and treatment allocation for the composite outcome for patients with and without history of CAD, respectively, p for interaction = (0.48).
Conclusion:
IL-1 blockade with anakinra in STEMI leads to similar reductions in systemic inflammation and improvement in HF-related outcomes inpatients both with and without history of CAD.
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