Inhibition of delta-protein kinase C by delcasertib as an adjunct to primary percutaneous coronary intervention for acute anterior ST-segment elevation myocardial infarction: Results of the PROTECTION AMI randomized controlled trial

A. Michael Lincoff, Matthew Roe, Philip Aylward, John Galla, Andrzej Rynkiewicz, Victor Guetta, Michael Zelizko, Neal Kleiman, Harvey White, Ellen McErlean, David Erlinge, Mika Laine, Jorge Manuel Dos Santos Ferreira, Shaun Goodman, Shamir Mehta, Dan Atar, Harry Suryapranata, Svend Eggert Jensen, T. Forster, Antonio Fernandez-OrtizDanny Schoors, Peter Radke, Guido Belli, Danielle Brennan, Gregory Bell, Mitchell Krucoff

Research output: Contribution to journalArticle

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Abstract

Aims Delcasertib is a selective inhibitor of delta-protein kinase C (delta-PKC), which reduced infarct size during ischaemia/ reperfusion in animal models and diminished myocardial necrosis and improved reperfusion in a pilot study during primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI).

Methods and results A multicentre, double-blind trial was performed in patients presenting within 6 h and undergoing primary PCI for anterior (the primary analysis cohort, n = 1010 patients) or inferior (an exploratory cohort, capped at 166 patients) STEMI. Patients with anterior STEMI were randomized to placebo or one of three doses of delcasertib (50,150, or450 mg/h) by intravenous infusion initiated before PCI and continued for ∼2.5 h.There were no differences between treatment groups in the primary efficacy endpoint of infarct size measured by creatine kinaseMB fraction area under the curve (AUC) (median 5156, 5043, 4419, and 5253 ng h/mL in the placebo, delcasertib 50, 150, and 450 mg/mL groups, respectively) in the anterior STEMI cohort. No treatment-related differences were seen in secondary endpoints of infarct size, electrocardiographic STsegment recovery AUC or time to stable ST recovery, or left ventricular ejection fraction at 3 months. No differences in rates of adjudicated clinical endpoints (death, heart failure, or serious ventricular arrhythmias) were observed.

Conclusions Selective inhibition of delta-PKC with intravenous infusion of delcasertib during PCI for acute STEMI in a population of patients treated according to contemporary standard of care did not reduce biomarkers of myocardial injury. Clinical trial registration ClinicalTrials.gov Identifier: NCT00785954.

Original languageEnglish
Pages (from-to)2516-2523
Number of pages8
JournalEuropean Heart Journal
Volume35
Issue number37
DOIs
Publication statusPublished - Oct 1 2014

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Protein Kinase C-delta
Percutaneous Coronary Intervention
Randomized Controlled Trials
Intravenous Infusions
Reperfusion
Area Under Curve
Placebos
Creatine
Standard of Care
Stroke Volume
Cardiac Arrhythmias
Cohort Studies
Necrosis
Ischemia
Animal Models
Heart Failure
Biomarkers
KAI 9803
ST Elevation Myocardial Infarction
Clinical Trials

Keywords

  • Myocardial
  • Myocardial infarction
  • Pharmacology
  • Reperfusion
  • Stents
  • Stunning

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Inhibition of delta-protein kinase C by delcasertib as an adjunct to primary percutaneous coronary intervention for acute anterior ST-segment elevation myocardial infarction : Results of the PROTECTION AMI randomized controlled trial. / Lincoff, A. Michael; Roe, Matthew; Aylward, Philip; Galla, John; Rynkiewicz, Andrzej; Guetta, Victor; Zelizko, Michael; Kleiman, Neal; White, Harvey; McErlean, Ellen; Erlinge, David; Laine, Mika; Dos Santos Ferreira, Jorge Manuel; Goodman, Shaun; Mehta, Shamir; Atar, Dan; Suryapranata, Harry; Jensen, Svend Eggert; Forster, T.; Fernandez-Ortiz, Antonio; Schoors, Danny; Radke, Peter; Belli, Guido; Brennan, Danielle; Bell, Gregory; Krucoff, Mitchell.

In: European Heart Journal, Vol. 35, No. 37, 01.10.2014, p. 2516-2523.

Research output: Contribution to journalArticle

Lincoff, AM, Roe, M, Aylward, P, Galla, J, Rynkiewicz, A, Guetta, V, Zelizko, M, Kleiman, N, White, H, McErlean, E, Erlinge, D, Laine, M, Dos Santos Ferreira, JM, Goodman, S, Mehta, S, Atar, D, Suryapranata, H, Jensen, SE, Forster, T, Fernandez-Ortiz, A, Schoors, D, Radke, P, Belli, G, Brennan, D, Bell, G & Krucoff, M 2014, 'Inhibition of delta-protein kinase C by delcasertib as an adjunct to primary percutaneous coronary intervention for acute anterior ST-segment elevation myocardial infarction: Results of the PROTECTION AMI randomized controlled trial', European Heart Journal, vol. 35, no. 37, pp. 2516-2523. https://doi.org/10.1093/eurheartj/ehu177
Lincoff, A. Michael ; Roe, Matthew ; Aylward, Philip ; Galla, John ; Rynkiewicz, Andrzej ; Guetta, Victor ; Zelizko, Michael ; Kleiman, Neal ; White, Harvey ; McErlean, Ellen ; Erlinge, David ; Laine, Mika ; Dos Santos Ferreira, Jorge Manuel ; Goodman, Shaun ; Mehta, Shamir ; Atar, Dan ; Suryapranata, Harry ; Jensen, Svend Eggert ; Forster, T. ; Fernandez-Ortiz, Antonio ; Schoors, Danny ; Radke, Peter ; Belli, Guido ; Brennan, Danielle ; Bell, Gregory ; Krucoff, Mitchell. / Inhibition of delta-protein kinase C by delcasertib as an adjunct to primary percutaneous coronary intervention for acute anterior ST-segment elevation myocardial infarction : Results of the PROTECTION AMI randomized controlled trial. In: European Heart Journal. 2014 ; Vol. 35, No. 37. pp. 2516-2523.
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abstract = "Aims Delcasertib is a selective inhibitor of delta-protein kinase C (delta-PKC), which reduced infarct size during ischaemia/ reperfusion in animal models and diminished myocardial necrosis and improved reperfusion in a pilot study during primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI).Methods and results A multicentre, double-blind trial was performed in patients presenting within 6 h and undergoing primary PCI for anterior (the primary analysis cohort, n = 1010 patients) or inferior (an exploratory cohort, capped at 166 patients) STEMI. Patients with anterior STEMI were randomized to placebo or one of three doses of delcasertib (50,150, or450 mg/h) by intravenous infusion initiated before PCI and continued for ∼2.5 h.There were no differences between treatment groups in the primary efficacy endpoint of infarct size measured by creatine kinaseMB fraction area under the curve (AUC) (median 5156, 5043, 4419, and 5253 ng h/mL in the placebo, delcasertib 50, 150, and 450 mg/mL groups, respectively) in the anterior STEMI cohort. No treatment-related differences were seen in secondary endpoints of infarct size, electrocardiographic STsegment recovery AUC or time to stable ST recovery, or left ventricular ejection fraction at 3 months. No differences in rates of adjudicated clinical endpoints (death, heart failure, or serious ventricular arrhythmias) were observed.Conclusions Selective inhibition of delta-PKC with intravenous infusion of delcasertib during PCI for acute STEMI in a population of patients treated according to contemporary standard of care did not reduce biomarkers of myocardial injury. Clinical trial registration ClinicalTrials.gov Identifier: NCT00785954.",
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T1 - Inhibition of delta-protein kinase C by delcasertib as an adjunct to primary percutaneous coronary intervention for acute anterior ST-segment elevation myocardial infarction

T2 - Results of the PROTECTION AMI randomized controlled trial

AU - Lincoff, A. Michael

AU - Roe, Matthew

AU - Aylward, Philip

AU - Galla, John

AU - Rynkiewicz, Andrzej

AU - Guetta, Victor

AU - Zelizko, Michael

AU - Kleiman, Neal

AU - White, Harvey

AU - McErlean, Ellen

AU - Erlinge, David

AU - Laine, Mika

AU - Dos Santos Ferreira, Jorge Manuel

AU - Goodman, Shaun

AU - Mehta, Shamir

AU - Atar, Dan

AU - Suryapranata, Harry

AU - Jensen, Svend Eggert

AU - Forster, T.

AU - Fernandez-Ortiz, Antonio

AU - Schoors, Danny

AU - Radke, Peter

AU - Belli, Guido

AU - Brennan, Danielle

AU - Bell, Gregory

AU - Krucoff, Mitchell

PY - 2014/10/1

Y1 - 2014/10/1

N2 - Aims Delcasertib is a selective inhibitor of delta-protein kinase C (delta-PKC), which reduced infarct size during ischaemia/ reperfusion in animal models and diminished myocardial necrosis and improved reperfusion in a pilot study during primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI).Methods and results A multicentre, double-blind trial was performed in patients presenting within 6 h and undergoing primary PCI for anterior (the primary analysis cohort, n = 1010 patients) or inferior (an exploratory cohort, capped at 166 patients) STEMI. Patients with anterior STEMI were randomized to placebo or one of three doses of delcasertib (50,150, or450 mg/h) by intravenous infusion initiated before PCI and continued for ∼2.5 h.There were no differences between treatment groups in the primary efficacy endpoint of infarct size measured by creatine kinaseMB fraction area under the curve (AUC) (median 5156, 5043, 4419, and 5253 ng h/mL in the placebo, delcasertib 50, 150, and 450 mg/mL groups, respectively) in the anterior STEMI cohort. No treatment-related differences were seen in secondary endpoints of infarct size, electrocardiographic STsegment recovery AUC or time to stable ST recovery, or left ventricular ejection fraction at 3 months. No differences in rates of adjudicated clinical endpoints (death, heart failure, or serious ventricular arrhythmias) were observed.Conclusions Selective inhibition of delta-PKC with intravenous infusion of delcasertib during PCI for acute STEMI in a population of patients treated according to contemporary standard of care did not reduce biomarkers of myocardial injury. Clinical trial registration ClinicalTrials.gov Identifier: NCT00785954.

AB - Aims Delcasertib is a selective inhibitor of delta-protein kinase C (delta-PKC), which reduced infarct size during ischaemia/ reperfusion in animal models and diminished myocardial necrosis and improved reperfusion in a pilot study during primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI).Methods and results A multicentre, double-blind trial was performed in patients presenting within 6 h and undergoing primary PCI for anterior (the primary analysis cohort, n = 1010 patients) or inferior (an exploratory cohort, capped at 166 patients) STEMI. Patients with anterior STEMI were randomized to placebo or one of three doses of delcasertib (50,150, or450 mg/h) by intravenous infusion initiated before PCI and continued for ∼2.5 h.There were no differences between treatment groups in the primary efficacy endpoint of infarct size measured by creatine kinaseMB fraction area under the curve (AUC) (median 5156, 5043, 4419, and 5253 ng h/mL in the placebo, delcasertib 50, 150, and 450 mg/mL groups, respectively) in the anterior STEMI cohort. No treatment-related differences were seen in secondary endpoints of infarct size, electrocardiographic STsegment recovery AUC or time to stable ST recovery, or left ventricular ejection fraction at 3 months. No differences in rates of adjudicated clinical endpoints (death, heart failure, or serious ventricular arrhythmias) were observed.Conclusions Selective inhibition of delta-PKC with intravenous infusion of delcasertib during PCI for acute STEMI in a population of patients treated according to contemporary standard of care did not reduce biomarkers of myocardial injury. Clinical trial registration ClinicalTrials.gov Identifier: NCT00785954.

KW - Myocardial

KW - Myocardial infarction

KW - Pharmacology

KW - Reperfusion

KW - Stents

KW - Stunning

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