• Joel P Giblett, Sophie Clarke, Tian Zhao, Liam M McCormick, Denise M Braganza, Cameron G Densem, Michael O'Sullivan, David Adlam, Sarah C Clarke, Jo Steele, Sarah Fielding, West Nick E J NEJ Department of Cardiology, Royal Papworth Hospital, Cambridge, United Kingdom., Sofia S Villar, and Stephen P Hoole.
• Department of Cardiology, Royal Papworth Hospital, Cambridge, United Kingdom; Department of Cardiovascular Medicine, University of Cambridge, United Kingdom.
• Am. Heart J. 2019 Sep 1; 215: 41-51.

BackgroundThe incretin hormone glucagon-like peptide 1 (GLP-1) has been shown to protect against lethal ischemia-reperfusion injury in animal models and against nonlethal ischemia reperfusion injury in humans. Furthermore, GLP-1 receptor agonists have been shown to reduce major adverse cardiovascular and cerebrovascular events (MACCE) in large-scale studies. We sought to investigate whether GLP-1 reduced percutaneous coronary intervention (PCI)-associated myocardial infarction (PMI) during elective PCI.MethodsThe study was a randomized, double-blind controlled trial in which patients undergoing elective PCI received an intravenous infusion of either GLP-1 at 1.2 pmol/kg/min or matched 0.9% saline placebo before and during the procedure. Randomization was performed in 1:1 fashion, with stratification for diabetes mellitus. Six-hour cardiac troponin I (cTnI) was measured with a primary end point of PMI defined as rise ≫×5 upper limit of normal (280 ng/L). Secondary end points included cTnI rise and MACCE at 12 months.ResultsA total of 192 patients were randomized with 152 (79%) male and a mean age of 68.1 ± 8.9 years. No significant differences in patient demographics were noted between the groups. There was no difference in the rate of PMI between GLP-1 and placebo (9 [9.8%] vs 8 [8.3%], P = 1.0) or in the secondary end points of difference in median cTnI between groups (9.5 [0-88.5] vs 20 [0-58.5] ng/L, P = .25) and MACCE at 12 months (7 [7.3%] vs 9 [9.4%], P = .61).ConclusionsIn this randomized, placebo-controlled trial, GLP-1 did not reduce the low incidence of PMI or abrogate biomarker rise during elective PCI, nor did it influence the 12-month MACCE rate which also remained low.Clinical Trial RegistrationClinicaltrials.gov Number: NCT02127996https://clinicaltrials.gov/ct2/show/NCT02127996.Copyright © 2019 Elsevier Inc. All rights reserved.

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