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

Inclusion Criteria:

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 intermittentpain lasting more than 12 hours, the time from the when the pain became severeand constant);

• ST segment elevation on ECG >1 mm in 2 or more anatomically contiguous leads;

• Reperfusion strategy planned or completed (including percutaneous coronaryintervention or fibrinolysis)

• Age >21 years.

Exclusion Criteria:

Subjects will not be eligible if they meet any of the following exclusion criteria.

• Pregnancy;

• Inability to obtain consent from patient;

• History of prior STEMI or of systolic heart failure (LVEF<40%);

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

• Duration of chest pain >12 hours at time of coronary artery catheterization (continuously - see exceptions in Inclusion Criteria) or coronary arteryintervention >12 hours earlier (see exceptions in Inclusion Criteria)[max durationof chest pain 24 hours];

• Failed reperfusion strategy (unsuccessful percutaneous coronary intervention);

• Need or plan for emergent cardiac surgery;

• Anticipated inability to complete a cardiopulmonary exercise test (CPET) on atreadmill at follow up visit at 42 days (i.e. amputee, wheel-chair bound, severenon-cardiac illness limiting mobility).

• Active infection (such as acute, i.e. COVID-19, or chronic/recurrent infectiousdisease i.e HBV, HCV, and HIV/AIDS-but excluding HCV+ patients with undetectableplasma RNA)

• Acute or chronic inflammatory disease or immunosuppressive therapies (including oralcorticosteroids at a dose of prednisone equivalent of 0.5 mg/kg/day but notincluding inhaled or low dose oral corticosteroids or non-steroidalanti-inflammatory drugs).

• Neutropenia (<1,500/mm3 or <1,000/mm3 in African-American patients).

• Active acute or chronic psychiatric illness that in the opinion of the investigatormay prevent from complying with study instructions;

• Stage V chronic kidney disease (estimated glomerular filtration rate 15mL/min/1.73m2 or less) or on renal-replacement therapy (a GFR ≥45 mL/min/1.73m2 isrequired for the cardiac magnetic resonance portion of the study);

• Limited English Proficiency that in the opinion of the investigator may prevent fromunderstanding the content of the informed consent form and instructions during thetests required for the study.

• Any comorbidity limiting survival or ability to complete the study.