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Endogenous natriuretic peptides seem to protect myocardium by blocking the renin-angiotensin-aldosterone system and stimulating mitochondrial adenosine triphosphate (ATP)-sensitive potassium (KATP) channels, blocking a key step in cell death. Japanese researchers conducted two parallel, single-blind trials in patients with first acute myocardial infarction, testing whether short-term postreperfusion treatment with atrial natriuretic peptide (ANP) or nicorandil (a direct KATP channel stimulant) might reduce infarct size or improve cardiovascular outcome.
In one trial, 569 patients were randomized to receive intravenous ANP or placebo for 3 days after reperfusion. The ANP group had a significant 15% reduction in infarct size (measured by area …