Primary
percutaneous coronary intervention (PCI) decreases myocardial damage in patients with
ST-elevation myocardial infarction (
STEMI). Cellular
reperfusion injury associated with
calcium overload may limit myocardial salvage. We previously showed (CASTEMI trial) that
caldaret (MCC-135), which modulates myocardial
calcium handling when administered before PCI in patients with
STEMI, did not change residual left ventricular (LV) function. The aim of this subanalysis was to examine whether
caldaret decreases the incidence of
LV dysfunction (LV ejection fraction <or=30%) in patients with
STEMI undergoing primary PCI. Of 387 patients enrolled in the CASTEMI study, 239 had single-photon emission computed tomographic data on days 7 and 30 after the
infarct. The incidence of
LV dysfunction in patients receiving low- and high-dose
caldaret was compared with placebo. At day 30 after the
infarct, there was a significant decrease in the incidence of
LV dysfunction in patients receiving low and high doses of
caldaret versus placebo (8.0%, 6.9% vs 17.5%, p <0.05 for the 2 comparisons). This difference was more pronounced in patients with anterior wall MI and Thrombolysis In
Myocardial Infarction grade 0/1 flow. In this group, 52% decrease in the incidence of
LV dysfunction was observed already on day 7 after the
infarct (p = 0.026). The incidence of an LV ejection fraction <or=30% was significantly decreased between day 7 and day 30 in patients treated with the 2 doses of
caldaret and was unchanged in the placebo group. In conclusion, treatment with intravenous
caldaret in patients with
STEMI undergoing primary PCI is associated with a significant decrease in the incidence of severe
LV dysfunction.