Human atrial natriuretic peptide significantly reduces both infarct size and readmissions for heart failure in patients undergoing angioplasty for acute myocardial infarction, according to a late-breaking clinical trial presented at the American Heart Association meeting.

The Japan-Working Groups of Acute Myocardial Infarction for the Reduction of Necrotic Damage by ANP or Nicorandil (J-WIND) randomized 1,216 Japanese patients admitted for angioplasty for acute myocardial infarction to one of two drugs---the peptide or the potassium channel activator nicorandil --- or placebo. Natriuretic peptide was given as an infusion for three days. Nicorandil patients received an initial dose followed by a 24-hour infusion.

Researchers analyzed 1,064 patients for infarct size and 1,104 patients for the endpoints of cardiac death, cardiovascular event, or heart failure. Natriuretic peptide reduced infarct size by nearly 14.7 percent and readmissions for heart failure by 83.6 percent. Nicorandil was associated with a 38-percent reduction in cardiac deaths, but neither infarct size nor improvement in overall survival rate changed relative to placebo.

“There are no other reports of the reduction of infarct size by any drug in large-scale trials using patients with acute heart attack,” said Musafumi Kitakaze, MD, PhD, director of the Cardiovascular Division of the National Cardiovascular Center in Suita, Japan. “These results will change the strategy of the acute-phase treatment of heart attack.”

“Our conclusion is that hANP is a hopeful adjunctive drug for reducing infarct size and subsequent re-hospitalization due to heart failure,” said Kitakaze, who was chair of the J-WIND trial. “While nicorandil did not reduce infarct size or improve overall survival rate, it holds the possibility of reducing cardiovascular mortality and therefore warrants further study.”