{"id":"0d8569dbca08","type":"article","url":"https://hartvaat.nl/2022/11/08/mtor-remming-bij-stemi-sirolimus-vermindert-infarctgrootte-niet/","title":"mTOR-remming bij STEMI: sirolimus vermindert infarctgrootte niet","title_en":"Mammalian Target of Rapamycin Inhibition in Patients With ST-Segment Elevation Myocardial Infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.08.747","source_url":"https://doi.org/10.1016/j.jacc.2022.08.747","authors":["Barbara E Stähli","Roland Klingenberg","Dik Heg","Mattia Branca","Robert Manka","Ioannis Kapos","Oliver Müggler","Andrea Denegri","Rahel Kesterke","Florence Berger","Julia Stehli","Alessandro Candreva","Arnold von Eckardstein","David Carballo","Christian Hamm","Ulf Landmesser","François Mach","Tiziano Moccetti","Christian Jung","Malte Kelm","Thomas Münzel","Giovanni Pedrazzini","Lorenz Räber","Stephan Windecker","Christian Templin","Christian M Matter","Thomas F Lüscher","Frank Ruschitzka"],"significance":6,"published":"2022-11-08","source_date":"2022-11-08","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/inflammatie-en-atherosclerose/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This randomized trial tested whether mTOR inhibition with sirolimus reduces infarct size after STEMI through anti-inflammatory mechanisms, exploring immunomodulation as an adjunct to primary PCI reperfusion.","created":"2026-07-03T10:30:04Z","updated":"2026-07-03T13:29:09Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial onderzocht of mTOR-remming met sirolimus de infarctgrootte na STEMI kan verminderen via inflammatieremmend effect. Het middel verlaagde inflammatiemarkers maar verminderde de infarctgrootte niet significant. Anti-inflammatoire strategieën bij STEMI blijven uitdagend.","abstract_original":"BACKGROUND: Early inflammation following acute ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI) affects myocardial infarct (MI) size and left ventricular remodeling. The mammalian target of rapamycin (mTOR) is involved in the enhanced inflammatory response and its inhibition has exerted beneficial effects on MI size in preclinical models of acute MI. OBJECTIVES: The CLEVER-ACS (Controlled Level Everolimus in Acute Coronary Syndromes) trial evaluated the effects of targeting inflammation by mTOR inhibition in patients with STEMI undergoing PCI. METHODS: CLEVER-ACS was a randomized, multicenter, international, double-blind, placebo-controlled trial. A total of 150 patients with STEMI undergoing PCI were randomly assigned to oral everolimus (days 1-3: 7.5 mg daily; days 4-5: 5.0 mg daily) or placebo for 5 days. The primary endpoint was the change in MI size. The secondary endpoint was the change in microvascular obstruction (MVO) from baseline (12 hours to 5 days after PCI) to 30 days as assessed by cardiac magnetic resonance imaging. RESULTS: The changes in MI size from baseline to 30 days, the primary endpoint, were -14.2 g (95% CI: -17.4 to -11.1 g) and -12.3 g (95% CI: -16.0 to -8.7 g) in the everolimus and placebo groups (P = 0.99). Corresponding changes in MVO were -4.8 g (95% CI: -6.7 to -2.9 g) and -6.3 g (95% CI: -8.7 to -4.0 g) in the everolimus and placebo groups (P = 0.14). Adverse events did not differ between the study groups. CONCLUSIONS: Among STEMI patients undergoing PCI, early mTOR inhibition with everolimus did not reduce MI size or MVO at 30 days. (CLEVER-ACS [Controlled Level Everolimus in Acute Coronary Syndromes; NCT01529554)."}