Interleukin-6 Inhibition for Patients with Acute Myocardial Infarction: A Systematic Review and Meta-Analysis

To explore the outcomes associated with interleukin-6 (IL-6) pathway blockade, using tocilizumab, in patients with ST-elevation myocardial infarction (STEMI) and non (NSTEMI). Acute myocardial infarction (AMI) denotes myocardial necrosis due to ischemia and presents in distinct electrocardiographic phenotypes. Inflammation driven by IL-6 contributes to ischemia-reperfusion injury, with tocilizumab showing promise in reducing myocardial damage and improving outcomes.

This work followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Framework and was registered in international prospective register of systematic reviews (PROSPERO). Relevant studies were identified through structured searches of PubMed, MEDLINE, the Cochrane Library, and Google Scholar up to June 2025, focusing on randomized and prospective investigations of IL-6 inhibition in AMI. Assessed outcomes included infarct size, inflammatory and cardiac biomarkers, major adverse cardiovascular events, and mortality.

Three randomized controlled trials including 344 patients were analyzed. All evaluated tocilizumab in STEMI or NSTEMI. Pooled data showed no significant difference between tocilizumab and placebo for recurrent myocardial infarction (relative risk [RR] = 0.47, 95% confidence limit [CI] = 0.07-3.05; I² = 44%; p = 0.43) or infection (RR = 0.85, 95% CI: 0.29-2.53; I² = 0%; p = 0.77). Mechanistic analysis demonstrated lower c-reactive protein (CRP) exposure, transient N-terminal pro-B-type natriuretic peptide (NT-proßNP) reductions, and attenuated troponin release in tocilizumab groups, indicating biological modulation of inflammatory and myocardial injury pathways during the acute phase. Benefits were greatest during hospitalization but diminished over time. Long-term outcomes, including ventricular remodeling, NT-proßNP at 6 months, and mortality, showed no significant group differences.

The IL-6 inhibition with tocilizumab demonstrates early anti-inflammatory and cardioprotective effects in AMI, but consistent clinical benefits remain unproven, underscoring the need for larger, long-term trials to confirm efficacy and safety.