Université d'Auvergne Clermont1 | CNRS

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Rationale and design of the Cyclosporine to ImpRove Clinical oUtcome in ST-elevation myocardial infarction patients (the CIRCUS trial).

TitleRationale and design of the Cyclosporine to ImpRove Clinical oUtcome in ST-elevation myocardial infarction patients (the CIRCUS trial).
Publication TypeJournal Article
Year of Publication2015
AuthorsMewton, N., T. T. Cung, O. Morel, G. Cayla, E. Bonnefoy-Cudraz, G. Rioufol, D. Angoulvant, P. Guerin, M. Elbaz, N. Delarche, P. Coste, G. Vanzetto, M. Metge, J. - F. Aupetit, B. Jouve, P. Motreff, C. Tron, J. - N. Labeque, P. G. Steg, Y. Cottin, G. Range, J. Clerc, P. Coussement, F. Prunier, F. Moulin, O. Roth, L. Belle, P. Dubois, P. Barragan, M. Gilard, C. Piot, P. Colin, M. - C. Morice, J. - P. Monassier, O. Ider, J. L. P. Dubois-Randé, T. Unterseeh, H. Lebreton, T. Beard, D. Blanchard, G. Grollier, V. Malquarti, P. Staat, A. Sudre, M. J. Hansson, E. Elmer, I. Boussaha, C. Jossan, A. Torner, M. Claeys, D. Garcia-Dorado, and M. Ovize
Corporate AuthorsCIRCUS Study Investigators
JournalAmerican heart journal
Volume169
Issue6
Pagination758-766.e6
Date Published2015 Jun
ISSN1097-6744
KeywordsBiological Markers, Coronary Angiography, Cyclosporine, Double-Blind Method, Echocardiography, Electrocardiography, Female, Humans, Male, Myocardial Infarction, Percutaneous Coronary Intervention, Prospective Studies, Time Factors, Treatment Outcome
Abstract

BACKGROUND: Both acute myocardial ischemia and reperfusion contribute to cardiomyocyte death in ST-elevation myocardial infarction (STEMI). The final infarct size is the principal determinant of subsequent clinical outcome in STEMI patients. In a proof-of-concept phase II trial, the administration of cyclosporine prior to primary percutaneous coronary intervention (PPCI) has been associated with a reduction of infarct size in STEMI patients.

METHODS: CIRCUS is an international, prospective, multicenter, randomized, double-blinded, placebo-controlled trial. The study is designed to compare the efficacy and safety of cyclosporine versus placebo, in addition to revascularization by PPCI, in patients presenting with acute anterior myocardial infarction within 12 hours of symptoms onset and initial TIMI flow ≤1 in the culprit left anterior descending coronary artery. Patients are randomized in a 1:1 fashion to 2.5 mg/kg intravenous infusion of cyclosporine or matching placebo performed in the minutes preceding PCI. The primary efficacy end point of CIRCUS is a composite of 1-year all-cause mortality, rehospitalization for heart failure or heart failure worsening during initial hospitalization, and left ventricular adverse remodeling as determined by sequential transthoracic echochardiography. Secondary outcomes will be tested using a hierarchical sequence of left ventricular (LV) ejection fraction and absolute measurements of LV volumes. The composite of death and rehospitalization for heart failure or heart failure worsening during initial hospitalization will be further assessed at three years after the initial infarction.

RESULTS: Recruitment lasted from April 2011 to February 2014. The CIRCUS trial has recruited 975 patients with acute anterior myocardial infarction. The 12-months results are expected to be available in 2015.

CONCLUSIONS: The CIRCUS trial is testing the hypothesis that cyclosporine in addition to early revascularization with PPCI compared to placebo in patients with acute anterior myocardial infarction reduces the incidence of death, heart failure and adverse LV remodeling at one-year follow-up.

DOI10.1016/j.ahj.2015.02.020
Alternate JournalAm. Heart J.