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Early treatments for heart attack have come a long way in recent years, but researchers are still looking for a drug to help protect what's left of the myocardium from ischaemic and reperfusion injuriesinjuries.. Atrial natriuretic peptide (ANP) is one candidate that looked promising in a recent clinical trial. Patients given the drug for three days after a percutaneous coronary intervention ended up with infarcts that were nearly 15% smaller than placebo controls (95% CI 3.0% to 24.9%). They also had slightly better ventricular function at six months and a lower risk of heart failure or death from cardiac disease (hazard ratio 0.27, 0.09 to 0.8). Another candidate drug, nicorandil, worked no better than placebo in a parallel trial by the same authors. Both drugs caused more serious hypotension than placebo.
ANP and nicorandil target a mitochondrial pore that is central to mechanisms of cell death during myocardial infarction. So it is odd that they performed so differently in these trials, says an editorial (p 1461). Perhaps the dose of nicorandil was too low. Or perhaps we have more to learn about the way it works. The evaluation of ANP is still at an early stage too, say the editorial's authors. Patients and doctors must wait for better data on dosing and safety, preferably from double blind trials.