Stimulation of the auricular vagus nerve in ST-Elevation Myocardial Infarction (STEMI)

Over the past decade, it has been shown that transcutaneous vagus nerve stimulation (tVNS) has a cardioprotective effect both in chronic heart failure and in coronary heart disease, preventing reperfusion injury and weakening myocardial remodeling.

The purpose of this study was to evaluate the prognostic effect of tVNS on hospital and long-term clinical outcomes in patients with STEMI.

Methods. A randomized, placebo-controlled trial. tVNS was performed on a group of patients who were eligible for the study according to the inclusion/exclusion criteria. tVNS was performed from the moment of admission to the PCI, during the PCI, and for the next 30 minutes after it. This clinical trial is registered with ClinicalTrials database under a unique identifier: NCT05992259.

Results. A total of 109 patients were included: 54 - Active tVNS, 55 - Sham tVNS. At the hospital stage, the levels of myocardial damage markers (troponin, CPKMB, NTproBNP) in dynamics (after 6, 72, and 96 hours) were significantly lower (p < 0.001) in the Active tVNS group. In this group, there was a lower incidence of cardiac arrhythmias (p < 0.001), cardiogenic shock (p = 0.044), and a better survival rate in the Active tVNS compared to the Sham tVNS (p=0.024). After 12 months, in the long term, trends towards differences in groups were found, without statistical significance. When comparing patient groups for survival by Kaplan–Meier, we obtained statistically insignificant log-rank tests in terms of total mortality (p = 0.618), in terms of the frequency of recurrent MI (p = 0.161), in terms of the frequency of hospitalization (p = 0.391), and in terms of the frequency of stroke (p = 0.490).

Conclusion. The use of tVNS in STEMI patients reduces myocardial damage, thereby reducing the incidence of hospital complications and hospital mortality. In the long term, there were trends towards differences in the groups in the frequency of MACE.