Cardiovascular Drugs and Therapy

, Volume 24, Issue 3, pp 289–295

Cardioprotection in the Clinical Setting-Lessons from J-WIND Studies

Article

Abstract

Introduction

Both prevention and attenuation of ischemic heart disease are important issues, and there are three different strategies to save patients from the deleterious sequelae of ischemic injury. The first strategy is to remove the causes of ischemic heart disease; the second is to attenuate on-going ischemic and reperfusion injury; the third is to prevent the progression of cardiac remodeling and chronic heart failure following ischemic injury.

Evidence and Discussion

For prevention of acute myocardial infarction, it is widely accepted to treat high risk patients with aspirin and/or statins. On the other hand, several medications such as angiotensin converting enzyme inhibitors, aldosterone receptor antagonists and beta blockers have been used for the prevention of post-infarction heart failure in patients who have suffered from an acute myocardial infarction. However, at present we do not have an adjunctive drug therapy to reduce infarct size in the acute phase in patients with myocardial infarction. Recently, the J-WIND trials suggested that an infusion of human atrial natriuretic peptide in the acute phase and oral administration of nicorandil in the chronic phase of infarction result in a better outcome in patients with a myocardial infarction. In this article we propose potential mechanisms for cardioprotection in patients with an acute myocardial infarction.

Key words

hANP Nicorandil Acute myocardial infarction Reperfusion injury Adjunctive therapy 

References

  1. 1.
    Rumana N, Kita Y, Turin TC, et al. Trend of increase in the incidence of acute myocardial infarction in a Japanese population: Takashima AMI Registry, 1990–2001. Am J Epidemiol. 2008;167:1358–64.CrossRefPubMedGoogle Scholar
  2. 2.
    Takii T, Yasuda S, Takahashi J, et al.. Trends in acute myocardial infarction incidence and mortality over 30 years in Japan: report from the MIYAGI-AMI Registry Study. Circ J. 2010;74:93-100.Google Scholar
  3. 3.
    Asakura M, Ueda Y, Yamaguchi O, et al. Extensive development of vulnerable plaques as a pan-coronary process in patients with myocardial infarction: an angioscopic study. J Am Coll Cardiol. 2001;37:1284–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Naghavi M, Libby P, Falk E, et al. From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I. Circulation. 2003;108:1664–72.CrossRefPubMedGoogle Scholar
  5. 5.
    Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators. Lancet. 1993;342:821–8.Google Scholar
  6. 6.
    Kober L, Torp-Pedersen C, Carlsen JE, et al. A clinical trial of the angiotensin-converting-enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. Trandolapril Cardiac Evaluation (TRACE) Study Group. N Engl J Med. 1995;333:1670–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Pfeffer MA, Braunwald E, Moye LA, et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators. N Engl J Med. 1992;327:669–77.CrossRefPubMedGoogle Scholar
  8. 8.
    Hayashi M, Tsutamoto T, Wada A, et al. Relationship between transcardiac extraction of aldosterone and left ventricular remodeling in patients with first acute myocardial infarction: extracting aldosterone through the heart promotes ventricular remodeling after acute myocardial infarction. J Am Coll Cardiol. 2001;38:1375–82.CrossRefPubMedGoogle Scholar
  9. 9.
    Pitt B, Remme W, Zannad F, et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med. 2003;348:1309–21.CrossRefPubMedGoogle Scholar
  10. 10.
    Dargie HJ. Effect of carvedilol on outcome after myocardial infarction in patients with left ventricular dysfunction: the CAPRICORN randomised trial. Lancet. 2001;357:1385–90.CrossRefPubMedGoogle Scholar
  11. 11.
    Dimmeler S, Zeiher AM, Schneider MD. Unchain my heart: the scientific foundations of cardiac repair. J Clin Invest. 2005;115:572–83.PubMedGoogle Scholar
  12. 12.
    Early administration of intravenous magnesium to high-risk patients with acute myocardial infarction in the Magnesium in Coronaries (MAGIC) Trial: a randomised controlled trial. Lancet. 2002;360:1189–96.Google Scholar
  13. 13.
    Ross AM, Gibbons RJ, Stone GW, Kloner RA, Alexander RW. A randomized, double-blinded, placebo-controlled multicenter trial of adenosine as an adjunct to reperfusion in the treatment of acute myocardial infarction (AMISTAD-II). J Am Coll Cardiol. 2005;45:1775–80.CrossRefPubMedGoogle Scholar
  14. 14.
    Bar FW, Tzivoni D, Dirksen MT, et al. Results of the first clinical study of adjunctive CAldaret (MCC-135) in patients undergoing primary percutaneous coronary intervention for ST-Elevation Myocardial Infarction: the randomized multicentre CASTEMI study. Eur Heart J. 2006;27:2516–23.CrossRefPubMedGoogle Scholar
  15. 15.
    Kopecky SL, Aviles RJ, Bell MR, et al. A randomized, double-blinded, placebo-controlled, dose-ranging study measuring the effect of an adenosine agonist on infarct size reduction in patients undergoing primary percutaneous transluminal coronary angioplasty: the ADMIRE (AmP579 Delivery for Myocardial Infarction REduction) study. Am Heart J. 2003;146:146–52.CrossRefPubMedGoogle Scholar
  16. 16.
    Wall TC, Califf RM, Blankenship J, et al. Intravenous fluosol in the treatment of acute myocardial infarction. Results of the Thrombolysis and Angioplasty in Myocardial Infarction 9 Trial. TAMI 9 Research Group. Circulation. 1994;90:114–20.PubMedGoogle Scholar
  17. 17.
    Zeymer U, Suryapranata H, Monassier JP, et al. The Na(+)/H(+) exchange inhibitor eniporide as an adjunct to early reperfusion therapy for acute myocardial infarction. Results of the evaluation of the safety and cardioprotective effects of eniporide in acute myocardial infarction (ESCAMI) trial. J Am Coll Cardiol. 2001;38:1644–50.CrossRefPubMedGoogle Scholar
  18. 18.
    Effect of 48-h intravenous trimetazidine on short- and long-term outcomes of patients with acute myocardial infarction, with and without thrombolytic therapy; A double-blind, placebo-controlled, randomized trial. The EMIP-FR Group. European Myocardial Infarction Project–Free Radicals. Eur Heart J. 2000;21:1537–46.Google Scholar
  19. 19.
    Faxon DP, Gibbons RJ, Chronos NA, Gurbel PA, Sheehan F. The effect of blockade of the CD11/CD18 integrin receptor on infarct size in patients with acute myocardial infarction treated with direct angioplasty: the results of the HALT-MI study. J Am Coll Cardiol. 2002;40:1199–204.CrossRefPubMedGoogle Scholar
  20. 20.
    Armstrong PW, Granger CB, Adams PX, et al. Pexelizumab for acute ST-elevation myocardial infarction in patients undergoing primary percutaneous coronary intervention: a randomized controlled trial. JAMA. 2007;297:43–51.CrossRefPubMedGoogle Scholar
  21. 21.
    Asanuma H, Minamino T, Sanada S, et al. Beta-adrenoceptor blocker carvedilol provides cardioprotection via an adenosine-dependent mechanism in ischemic canine hearts. Circulation. 2004;109:2773–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Kitakaze M, Hori M. It is time to ask what adenosine can do for cardioprotection. Heart Vessels. 1998;13:211–28.PubMedGoogle Scholar
  23. 23.
    He J, Chen Y, Huang Y, et al. Effect of long-term B-type natriuretic peptide treatment on left ventricular remodeling and function after myocardial infarction in rats. Eur J Pharmacol. 2009;602:132–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Hayashi M, Tsutamoto T, Wada A, et al. Intravenous atrial natriuretic peptide prevents left ventricular remodeling in patients with first anterior acute myocardial infarction. J Am Coll Cardiol. 2001;37:1820–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Ito H, Taniyama Y, Iwakura K, et al. Intravenous nicorandil can preserve microvascular integrity and myocardial viability in patients with reperfused anterior wall myocardial infarction. J Am Coll Cardiol. 1999;33:654–60.CrossRefPubMedGoogle Scholar
  26. 26.
    Asakura M, Jiyoong K, Minamino T, Shintani Y, Asanuma H, Kitakaze M. Rationale and design of a large-scale trial using atrial natriuretic peptide (ANP) as an adjunct to percutaneous coronary intervention for ST-segment elevation acute myocardial infarction: Japan-Working groups of acute myocardial infarction for the reduction of Necrotic Damage by ANP (J-WIND-ANP). Circ J. 2004;68:95–100.CrossRefPubMedGoogle Scholar
  27. 27.
    Minamino T, Jiyoong K, Asakura M, Shintani Y, Asanuma H, Kitakaze M. Rationale and design of a large-scale trial using nicorandil as an adjunct to percutaneous coronary intervention for ST-segment elevation acute myocardial infarction: Japan-Working groups of acute myocardial infarction for the reduction of Necrotic Damage by a K-ATP channel opener (J-WIND-KATP). Circ J. 2004;68:101–6.CrossRefPubMedGoogle Scholar
  28. 28.
    Kitakaze M, Asakura M, Kim J, et al. Human atrial natriuretic peptide and nicorandil as adjuncts to reperfusion treatment for acute myocardial infarction (J-WIND): two randomised trials. Lancet. 2007;370:1483–93.CrossRefPubMedGoogle Scholar
  29. 29.
    Kasama S, Toyama T, Hatori T, et al. Effects of intravenous atrial natriuretic peptide on cardiac sympathetic nerve activity and left ventricular remodeling in patients with first anterior acute myocardial infarction. J Am Coll Cardiol. 2007;49:667–74.CrossRefPubMedGoogle Scholar
  30. 30.
    Kuga H, Ogawa K, Oida A, et al. Administration of atrial natriuretic peptide attenuates reperfusion phenomena and preserves left ventricular regional wall motion after direct coronary angioplasty for acute myocardial infarction. Circ J. 2003;67:443–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Hata N, Seino Y, Tsutamoto T, et al. Effects of carperitide on the long-term prognosis of patients with acute decompensated chronic heart failure: the PROTECT multicenter randomized controlled study. Circ J. 2008;72:1787–93.CrossRefPubMedGoogle Scholar
  32. 32.
    Kobayashi Y, Goto Y, Daikoku S, et al. Cardioprotective effect of intravenous nicorandil in patients with successful reperfusion for acute myocardial infarction. Jpn Circ J. 1998;62:183–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Ikeda N, Yasu T, Kubo N, et al. Nicorandil versus isosorbide dinitrate as adjunctive treatment to direct balloon angioplasty in acute myocardial infarction. Heart. 2004;90:181–5.CrossRefPubMedGoogle Scholar
  34. 34.
    Ishii H, Ichimiya S, Kanashiro M, et al. Impact of a single intravenous administration of nicorandil before reperfusion in patients with ST-segment-elevation myocardial infarction. Circulation. 2005;112:1284–8.CrossRefPubMedGoogle Scholar
  35. 35.
    Toyama T, Seki R, Hoshizaki H, et al. Nicorandil administration shows cardioprotective effects in patients with poor TIMI and collateral flow as well as good flow after AMI. Ann Nucl Med. 2006;20:277–85.CrossRefPubMedGoogle Scholar
  36. 36.
    Kasama S, Toyama T, Kumakura H, et al. Effects of nicorandil on cardiac sympathetic nerve activity after reperfusion therapy in patients with first anterior acute myocardial infarction. Eur J Nucl Med Mol Imaging. 2005;32:322–8.CrossRefPubMedGoogle Scholar
  37. 37.
    Iwakura K, Ito H, Okamura A, et al. Nicorandil treatment in patients with acute myocardial infarction: a meta-analysis. Circ J. 2009;73:925–31.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of Clinical ResearchNational Cerebral and Cardiovascular CenterSuitaJapan
  2. 2.Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan

Personalised recommendations