Multimodality Cardiovascular Imaging for the Translation of Therapies for Vascular Activation After MI

Multimodality Cardiovascular Imaging for the Translation of Therapies for Vascular Activation After MI

Subjects with urgently reperfused type I myocardial infarction (MI) will be recruited and randomized to receive either placebo or the oral inflammasome (NLRP3) inhibitor dapansutrile. The primarily outcome measure will be carotid plaque volume change over 6 months; secondary outcome measures will be plaque inflammatory activity and coronary microvascular function.

Inclusion Criteria:

• Acute type I myocardial infarction (NSTEMI or STEMI)
• Reperfusion therapy planned or performed within prior 48 hrs
• Carotid or femoral artery plaque at baseline, or carotid intima media thickness >1.5 mm

Exclusion Criteria:

• Type II MI
• Failed primary PCI or need for emergent bypass surgery
• Severe heart failure (NYHA class IV)
• Life-threatening complication of MI (myocardial rupture, ischemic VSD, papillary muscle rupture)
• Refractory ventricular arrhythmias
• Allergy to dapansutril, OLT177, or drugs in the same class
• Co-morbidity limiting 6 month survival
• Active malignancy or recent malignancy with any systemic anti-cancer treatment
• Active infection
• Use of immunosuppressive medications or immunodeficiency disorder
• Neutropenia (ANC <2,000)
• Moderate or severe renal impairment (GFR <30 ml/min)
• Recent stroke (within previous 3 months)
• Allergy to ultrasound enhancing agents or polyethylene glycol
• Pregnancy or breastfeeding