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Type: Journal article
Title: Intravenous sodium nitrite in acute ST-elevation myocardial infarction: a randomized controlled trial (NIAMI)
Author: Siddiqi, N.
Neil, C.
Bruce, M.
MacLennan, G.
Cotton, S.
Papadopoulou, S.
Feelisch, M.
Bunce, N.
Lim, P.
Hildick-Smith, D.
Horowitz, J.
Madhani, M.
Boon, N.
Dawson, D.
Kaski, J.
Frenneaux, M.
Citation: European Heart Journal, 2014; 35(19):1255-+
Publisher: Oxford University Press
Issue Date: 2014
ISSN: 0195-668X
Statement of
Nishat Siddiqi, Christopher Neil, Margaret Bruce, Graeme MacLennan, Seonaidh Cotton, Sofia Papadopoulou, Martin Feelisch, Nicholas Bunce, Pitt O. Lim, David Hildick-Smith, John Horowitz, Melanie Madhani, Nicholas Boon, Dana Dawson, Juan Carlos Kaski and Michael Frenneaux, NIAMI investigators
Abstract: Aim: Despite prompt revascularization of acute myocardial infarction (AMI), substantial myocardial injury may occur, in part a consequence of ischaemia reperfusion injury (IRI). There has been considerable interest in therapies that may reduce IRI. In experimental models of AMI, sodium nitrite substantially reduces IRI. In this double-blind randomized placebo controlled parallel-group trial, we investigated the effects of sodium nitrite administered immediately prior to reperfusion in patients with acute ST-elevation myocardial infarction (STEMI). Methods and results: A total of 229 patients presenting with acute STEMI were randomized to receive either an i.v. infusion of 70 μmol sodium nitrite (n = 118) or matching placebo (n = 111) over 5 min immediately before primary percutaneous intervention (PPCI). Patients underwent cardiac magnetic resonance imaging (CMR) at 6-8 days and at 6 months and serial blood sampling was performed over 72 h for the measurement of plasma creatine kinase (CK) and Troponin I. Myocardial infarct size (extent of late gadolinium enhancement at 6-8 days by CMR-the primary endpoint) did not differ between nitrite and placebo groups after adjustment for area at risk, diabetes status, and centre (effect size -0.7% 95% CI: -2.2%, +0.7%; P = 0.34). There were no significant differences in any of the secondary endpoints, including plasma troponin I and CK area under the curve, left ventricular volumes (LV), and ejection fraction (EF) measured at 6-8 days and at 6 months and final infarct size (FIS) measured at 6 months. Conclusions: Sodium nitrite administered intravenously immediately prior to reperfusion in patients with acute STEMI does not reduce infarct size.
Keywords: Acute myocardial infarction; ischaemia-reperfusion injury; cardioprotection; nitrite
Rights: ©The Author 2014. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.
RMID: 0030067691
DOI: 10.1093/eurheartj/ehu096
Appears in Collections:Medicine publications

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