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Differential Outcomes With Edetate Disodium-Based Treatment Among Stable Post Anterior vs. Non-Anterior Myocardial Infarction Patients.

Publication ,  Journal Article
Lewis, EF; Ujueta, F; Lamas, GA; Roberts, RS; Mark, DB; Nahin, RL; Goertz, C; Stylianou, M; Lee, KL
Published in: Cardiovasc Revasc Med
November 2020

BACKGROUND: The Trial to Assess Chelation Therapy (TACT) found that chelation therapy significantly reduced clinical events in patients with a history of myocardial infarction (MI). The initial report of TACT included the observation of an interaction between edetate disodium infusions and MI location, as well as diabetes. Thus, we examined in greater detail the effect of edetate disodium chelation therapy as a function of MI location and diabetes. METHODS: Patients (n = 1708) at least 6 weeks post-MI and age ≥ 50 were randomized to receive 40 infusions of a 500 mL chelation solution or placebo (median follow-up 55 months). The effect of edetate disodium on the primary outcome (all-cause mortality, MI, stroke, hospitalization for angina, or coronary revascularization) was assessed as a function of MI location using log-rank test and Cox regression model, adjusting for other prognostic variables. RESULTS: Among patients with post anterior MI (n = 674), chelation was associated with a lower risk of the primary endpoint (HR 0.63, 95% CI 0.47-0.86, p = 0.003) among anterior MI patients, but not in post non-anterior MI (n = 1034) patients (HR 0.96, 95% CI 0.77-1.20, p = 0.702) (p-for-interaction = 0.032). The point estimates for each component of the primary endpoint favored chelation therapy. The differing treatment effect in patients with post anterior vs. non-anterior MI was consistent among patients with or without diabetes and remained significant after adjusting for other prognostic variables (p < 0.01). CONCLUSIONS: Edetate disodium infusions reduced the risk of cardiovascular events among patients with a prior anterior MI. Future studies should focus on replicating these results and understanding the mechanisms of benefit.

Duke Scholars

Published In

Cardiovasc Revasc Med

DOI

EISSN

1878-0938

Publication Date

November 2020

Volume

21

Issue

11

Start / End Page

1389 / 1395

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Myocardial Infarction
  • Middle Aged
  • Humans
  • Edetic Acid
  • Chelation Therapy
  • Chelating Agents
  • Cardiovascular System & Hematology
  • Angina Pectoris
  • 3201 Cardiovascular medicine and haematology
 

Citation

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Lewis, E. F., Ujueta, F., Lamas, G. A., Roberts, R. S., Mark, D. B., Nahin, R. L., … Lee, K. L. (2020). Differential Outcomes With Edetate Disodium-Based Treatment Among Stable Post Anterior vs. Non-Anterior Myocardial Infarction Patients. Cardiovasc Revasc Med, 21(11), 1389–1395. https://doi.org/10.1016/j.carrev.2020.04.005
Lewis, Eldrin F., Francisco Ujueta, Gervasio A. Lamas, Rhonda S. Roberts, Daniel B. Mark, Richard L. Nahin, Christine Goertz, Mario Stylianou, and Kerry L. Lee. “Differential Outcomes With Edetate Disodium-Based Treatment Among Stable Post Anterior vs. Non-Anterior Myocardial Infarction Patients.Cardiovasc Revasc Med 21, no. 11 (November 2020): 1389–95. https://doi.org/10.1016/j.carrev.2020.04.005.
Lewis EF, Ujueta F, Lamas GA, Roberts RS, Mark DB, Nahin RL, et al. Differential Outcomes With Edetate Disodium-Based Treatment Among Stable Post Anterior vs. Non-Anterior Myocardial Infarction Patients. Cardiovasc Revasc Med. 2020 Nov;21(11):1389–95.
Lewis, Eldrin F., et al. “Differential Outcomes With Edetate Disodium-Based Treatment Among Stable Post Anterior vs. Non-Anterior Myocardial Infarction Patients.Cardiovasc Revasc Med, vol. 21, no. 11, Nov. 2020, pp. 1389–95. Pubmed, doi:10.1016/j.carrev.2020.04.005.
Lewis EF, Ujueta F, Lamas GA, Roberts RS, Mark DB, Nahin RL, Goertz C, Stylianou M, Lee KL. Differential Outcomes With Edetate Disodium-Based Treatment Among Stable Post Anterior vs. Non-Anterior Myocardial Infarction Patients. Cardiovasc Revasc Med. 2020 Nov;21(11):1389–1395.
Journal cover image

Published In

Cardiovasc Revasc Med

DOI

EISSN

1878-0938

Publication Date

November 2020

Volume

21

Issue

11

Start / End Page

1389 / 1395

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Myocardial Infarction
  • Middle Aged
  • Humans
  • Edetic Acid
  • Chelation Therapy
  • Chelating Agents
  • Cardiovascular System & Hematology
  • Angina Pectoris
  • 3201 Cardiovascular medicine and haematology