Effects of the P-Selectin Antagonist Inclacumab on Myocardial Damage After Percutaneous Coronary Intervention According to Timing of Infusion: Insights from the SELECT-ACS Trial

Background--the effects of the p-selectin antagonist inclacumab on myocardial damage after percutaneous coronary intervention for non-st-segment elevation myocardial infarction (select-acs) trial suggested beneficial effects of inclacumab,a monoclonal antibody directed against p-selectin,on periprocedural myocardial damage. this study evaluated the effect of inclacumab on myocardial damage according to varying time intervals between study drug infusion and percutaneous coronary intervention (pci). methods and results--patients (n=544) enrolled in the select-acs trial and randomized to receive 1 infusion of placebo or inclacumab (5 or 20 mg/kg,administered between 1 and 24 hours before pci) were divided according to the time interval between study drug infusion and pci. the primary end point was the change in troponin i from baseline at 16 and 24 hours after pci. in patients receiving inclacumab 20 mg/kg with a short (less than median) time interval between infusion and pci,placebo-adjusted geometric mean percent changes in troponin i,creatine kinase-myocardial band,and peak troponin i at 24 hours were 45.6% (p=0.005),30.7% (p=0.01),and 37.3% (p=0.02),respectively. no significant changes were observed in patients with a long (greater than median) time interval between infusion and pci. placebo-adjusted geometric mean percent changes in troponin i and creatine kinase-myocardial band were 43.5% (p=0.02) and 26.0% (p=0.07),respectively,when inclacumab 20 mg/kg was administered between 1 and 3 hours before pci,whereas the drug had no effect with longer intervals. conclusions--inclacumab 20 mg/kg significantly reduces myocardial damage after pci in patients with non-st-segment elevation myocardial infarction,and benefits are larger when the infusion is administered <3 hours before pci. © 2016 the authors.