Mitigating Reperfusion Injury and Infarct Size With Dexrazoxane in Acute STEMI

Article Impact Level: HIGH
Data Quality: STRONG
Summary of  European Heart Journal https://doi.org/10.1093/eurheartj/ehag715
Dr. Keyur P Vora et al.

Points

Indiana University researchers conducted the Phase 2 SHIELD-MI trial evaluating peri-procedural intravenous dexrazoxane in one hundred twenty-three patients with ST-segment elevation myocardial infarction undergoing primary angioplasty.
Cardiac magnetic resonance imaging performed forty-eight to seventy-two hours post-reperfusion demonstrated a sixty-eight percent reduction in intramyocardial hemorrhage burden among dexrazoxane-treated patients versus placebo.
Patients receiving the four-dose dexrazoxane protocol achieved a thirty-four percent reduction in total myocardial infarct size compared with clinically matched control group participants.
Treatment with dexrazoxane promoted superior left ventricular ejection fraction preservation, supporting enhanced functional recovery of the primary cardiac pumping chamber following acute ischemia.
No serious treatment-related adverse events were observed during the trial, validating the drug safety profile for cardioprotective peri-reperfusion administration in emergency settings.

Summary

This phase 2 study evaluated the therapeutic efficacy and safety of peri-procedural intravenous dexrazoxane (DXZ) for mitigating reperfusion-induced intramyocardial hemorrhage (IMH) and myocardial injury in patients with ST-segment elevation myocardial infarction (STEMI). Led by Dr. Keyur Vora and Dr. Rohan Dharmakumar at the Indiana University School of Medicine, the single-center, double-blind, placebo-controlled SHIELD-MI trial enrolled 123 STEMI patients undergoing primary percutaneous coronary intervention (PCI). The study sought to determine whether targeting the peri-reperfusion window with DXZ could limit hemorrhagic microvascular damage, which affects approximately 40% of STEMI patients and confers a sixfold increased risk of major adverse cardiovascular events (MACE).

The trial’s primary efficacy analysis compared a clinically matched cohort of 50 patients divided equally into two treatment arms: 25 receiving a fixed four-dose regimen of IV dexrazoxane (administered immediately prior to PCI and at 4, 8, and 12 hours post-PCI) and 25 receiving placebo. Quantitative cardiac magnetic resonance imaging (CMR) performed 48 to 72 hours post-PCI demonstrated a 68% reduction in IMH burden and a 34% reduction in overall myocardial infarct size among patients treated with dexrazoxane. Furthermore, dexrazoxane administration resulted in superior preservation of left ventricular ejection fraction (LVEF) compared to placebo.

Safety evaluations revealed that peri-procedural IV dexrazoxane administration was well tolerated, with no treatment-related serious adverse events reported. These findings demonstrate that targeting microvascular hemorrhagic injury during primary PCI can successfully reduce myocardial damage and preserve left ventricular systolic function. The authors conclude that peri-procedural dexrazoxane represents a promising novel cardioprotective strategy, warranting larger randomized multicenter clinical trials to confirm its long-term impact on major adverse cardiovascular events and heart failure prevention.

Link to the article: https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehag715/8772199?login=false

References

Vora, K. P., Bhatt, K., Doshi, S., Poptani, V., Kumar, A., Finney, R., Taub, C., Reed, G., Puri, R., Tamarappoo, B., Fry, E., Henry, T., Traverse, J., Kalra, A., & Dharmakumar, R. (2026). Intravenous dexrazoxane for haemorrhagic myocardial infarction: The SHIELD-MI study. European Heart Journal, ehag715. https://doi.org/10.1093/eurheartj/ehag715