Etanercept Treating Patient With Acute ST Segment Elevated Myocardial Infarction

• Composite endpoint of major cardiovascular events, non-elective coronary revascularization procedures and hospitalization for unstable angina Cardiovascular death Non-fatal myocardial infarction Non-fatal stroke of all classifications [ Time Frame: 30 days ] [ Designated as safety issue: Yes ]
• Elevation of ALT, AST and CK [ Time Frame: 30 days ] [ Designated as safety issue: No ]
• serum adiponectin concentration, activity and isoforms [ Time Frame: 30 days ] [ Designated as safety issue: No ]

Our aim is to observe whether anti-TNF-alpha regimen will effect serum adiponectin concentration after myocardial infarction/reperfusion and also beneficial for the patients undergoing percutaneous coronary intervention (PCI).

Ischemic/reperfusion injury in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) is associated with increased inflammatory cytokines that including TNF-alpha that can exert deleterious effects and therefore contribute to cardiac dysfunction and cardiomyocytes apoptosis. Several studies on rodents have reported administration of sTNFR-Fc, a scavenger of the pro-inflammatory cytokine TNF-alpha at the time of reperfusion would protect against ischemic/reperfusion injury. Also reports had shown that serum TNF-alpha concentration is negatively correlated with a cardioprotective cytokine adiponectin. Adiponectin (Ad) is an abundant protein hormone regulatory of numerous metabolic processes. The major intracellular pathway activated by Ad includes phosphorylation of AMP-activated protein kinase, which is responsible for many of Ad's metabolic regulatory, anti-inflammatory, vascular protective, and anti-ischemic properties. The aim of the present study was to verify whether the administration of Etanercept, an FDA approved rheumatoid arthritis treating sTNFR-Fc, at the reperfusion time would protect against ischemic/reperfusion injury on patient, and effect serum adiponectin level.

• Drug: Etanercept
  Etanercept 25mg in 1ml(subcutaneous injection)at 2h and 72h after PCI
  Other Name: Enbrel
• Drug: saline
  saline 1ml(subcutaneous injection) at 2h and 72h after PCI

• Experimental: Etanercept
  Intervention: Drug: Etanercept
• Placebo Comparator: saline
  Intervention: Drug: saline

Inclusion Criteria:

• patients with acute ST segment elevated myocardial infarction in 12h

Exclusion Criteria:

• Cardiogenic shock
• old myocardial infarction
• other causes of cardiac insufficiency
• tumor
• Coronary anatomy unsuitable for PCI or Need of emergency coronary artery by-pass grafting
• Pregnancy