Interleukin-1 Blockade in Acute Myocardial Infarction to Prevent Heart Failure

Prior treatment

• Contraindications to treatment with anakinra (i.e. prior allergic reaction to Kineret® or E. coli derived products);

Other illness

• Need or plan for emergent cardiac surgery;
• Anticipated inability to complete a cardiopulmonary exercise test (CPET) on a treadmill at follow up visit at 42 days (i.e. amputee, wheel-chair bound, severe non-cardiac illness limiting mobility).
• Active infection (such as acute, i.e. COVID-19, or chronic/recurrent infectious disease i.e HBV, HCV, and HIV/AIDS-but excluding HCV+ patients with undetectable plasma RNA)
• Acute or chronic inflammatory disease or immunosuppressive therapies (including oral corticosteroids at a dose of prednisone equivalent of 0.5 mg/kg/day but not including inhaled or low dose oral corticosteroids or non-steroidal anti-inflammatory drugs).
• Active acute or chronic psychiatric illness that in the opinion of the investigator may prevent from complying with study instructions;

Lab values

• History of prior STEMI or of systolic heart failure (LVEF\<40%);
• Stage V chronic kidney disease (estimated glomerular filtration rate 15 mL/min/1.73m2 or less) or on renal-replacement therapy (a GFR ≥45 mL/min/1.73m2 is required for the cardiac magnetic resonance portion of the study);

Other

• Subjects will not be eligible if they meet any of the following exclusion criteria.
• Pregnancy;
• Inability to obtain consent from patient;
• Duration of chest pain \>12 hours at time of coronary artery catheterization (continuously - see exceptions in Inclusion Criteria) or coronary artery intervention \>12 hours earlier (see exceptions in Inclusion Criteria)\[max duration of chest pain 24 hours\];
• Failed reperfusion strategy (unsuccessful percutaneous coronary intervention);
• Neutropenia (\<1,500/mm3 or \<1,000/mm3 in African-American patients).
• Limited English Proficiency that in the opinion of the investigator may prevent from understanding the content of the informed consent form and instructions during the tests required for the study.
• Any comorbidity limiting survival or ability to complete the study.

• All criteria need to be met.
• Acute ST segment elevation myocardial infarction defined as:
  • chest pain, consistent with angina, within the prior 12 hours (for intermittent pain lasting more than 12 hours, the time from the when the pain became severe and constant);
  • ST segment elevation on ECG \>1 mm in 2 or more anatomically contiguous leads;
  • Reperfusion strategy planned or completed (including percutaneous coronary intervention or fibrinolysis)
• Age \>21 years.