H₂S donor does not reduce infarct size after STEMI

The Groningen Intervention Study For The Preservation Of Cardiac Function With Sodium Thiosulfate After ST-segment Elevation Myocardial Infarction (GIPS-IV)

News - Apr. 12, 2022

Presented at ACC.22 by **Marie-Sophie de Koning, MD (Groningen, The Netherlands)

Introduction and methods

Sodium thiosulfate is a strong antioxidant and H₂S donor, which has an established clinical safety profile. There is preclinical evidence that shows that administration of H₂S or H₂S donating compounds prevent damage after heart attack in animal studies.

The aim of the trial was to investigate whether sodium thiosulfate can reduce damage after a heart attack to ultimately improve prognosis.

Eligible patients who presented with a first STEMI were randomized to sodium thiosulfate (n=186) or matching placebo (n=187). The first dose was given directly at the cath lab and the second dose was administered 6 hours later.

The primary outcome was infarct size measured by cardiac magnetic resonance imaging at 4 months


  • There was no difference in infarct size after 4 months between the two groups.
  • The secondary outcomes of LVEF, enzymatic infarct size, and NT-proBNP levels were not different between the two groups after 4 months.
  • Rate of MACE appeared to be similar between the two treatment arms, and an increase in nausea and vomiting was observed in the sodium thiosulfate group.


In the GIPS-IV trial, administration of sodium thiosulfate did not reduce damage after heart attack. “Future studies should establish the role of H₂S in protecting the heart against damage, as this study does not exclude H₂S in total as a potential new therapy”, concluded De Koning.


The discussant,**Prof. Roxane Mehran (New York, NY, USA) said that the infarct sizes in these patients were small; the investigators did a great job in treating these patients quickly, making it difficult to demonstrate benefit with a new compound.

– Our coverage of ACC.22 is based on the information provided during the congress –

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