Rationale and design of the Cyclosporine to ImpRove Clinical oUtcome in ST-elevation myocardial infarction patients (the CIRCUS trial)

Forskningsoutput: TidskriftsbidragArtikel i vetenskaplig tidskrift


Background Both acute myocardial ischemia and reperfusion contribute to cardiomyocyte death in ST-elevation myocardial infarction (STEMI). The final infarct size is the principal determinant of subsequent clinical outcome in STEMI patients. In a proof-of-concept phase II trial, the administration of cyclosporine prior to primary percutaneous coronary intervention (PPCI) has been associated with a reduction of infarct size in STEMI patients. Methods CIRCUS is an international, prospective, multicenter, randomized, double-blinded, placebo-controlled trial. The study is designed to compare the efficacy and safety of cyclosporine versus placebo, in addition to revascularization by PPCI, in patients presenting with acute anterior myocardial infarction within 12 hours of symptoms onset and initial TIMI flow <= 1 in the culprit left anterior descending coronary artery. Patients are randomized in a 1: 1 fashion to 2.5 mg/kg intravenous infusion of cyclosporine or matching placebo performed in theminutes preceding PCI. The primary efficacy end point of CIRCUS is a composite of 1-year all-cause mortality, rehospitalization for heart failure or heart failure worsening during initial hospitalization, and left ventricular adverse remodeling as determined by sequential transthoracic echochardiography. Secondary outcomes will be tested using a hierarchical sequence of left ventricular (LV) ejection fraction and absolute measurements of LV volumes. The composite of death and rehospitalization for heart failure or heart failure worsening during initial hospitalization will be further assessed at three years after the initial infarction. Results Recruitment lasted from April 2011 to February 2014. The CIRCUS trial has recruited 975 patients with acute anterior myocardial infarction. The 12-months results are expected to be available in 2015. Conclusions The CIRCUS trial is testing the hypothesis that cyclosporine in addition to early revascularization with PPCI compared to placebo in patients with acute anterior myocardial infarction reduces the incidence of death, heart failure and adverse LV remodeling at one-year follow-up.


  • Nathan Mewton
  • Thien T. Cung
  • Olivier Morel
  • Guillaume Cayla
  • Eric Bonnefoy-Cudraz
  • Gilles Rioufol
  • Denis Angoulvant
  • Patrice Guerin
  • Meyer Elbaz
  • Nicolas Delarche
  • Pierre Coste
  • Gerald Vanzetto
  • Marc Metge
  • Jean-Francois Aupetit
  • Bernard Jouve
  • Pascal Motreff
  • Christophe Tron
  • Jean-Noel Labeque
  • Pierre G. Steg
  • Yves Cottin
  • Gregoire Range
  • Jerome Clerc
  • Patrick Coussement
  • Fabrice Prunier
  • Frederique Moulin
  • Olivier Roth
  • Loic Belle
  • Phillipe Dubois
  • Paul Barragan
  • Martine Gilard
  • Christophe Piot
  • Patrice Colin
  • Marie-Claude Morice
  • Jean-Pierre Monassier
  • Omar Ider
  • Jean Luc P. Dubois-Rande
  • Thierry Unterseeh
  • Herve Lebreton
  • Thierry Beard
  • Didier Blanchard
  • Gilles Grollier
  • Vincent Malquarti
  • Patrick Staat
  • Arnaud Sudre
  • Inesse Boussaha
  • Claire Jossan
  • Anna Torner
  • Marc Claeys
  • David Garcia-Dorado
  • Michel Ovize
Enheter & grupper

Ämnesklassifikation (UKÄ) – OBLIGATORISK

  • Kardiologi
Sidor (från-till)758-766.e6
TidskriftAmerican Heart Journal
Utgåva nummer6
StatusPublished - 2015
Peer review utfördJa