Effect of postconditioning on infarct size in patients with ST elevation myocardial infarction

• Published in: Heart (British Cardiac Society) Vol. 96; no. 21; pp. 1710 - 1715
• Main Authors: Sörensson, Peder, Saleh, Nawzad, Bouvier, Frederic, Böhm, Felix, Settergren, Magnus, Caidahl, Kenneth, Tornvall, Per, Arheden, Håkan, Rydén, Lars, Pernow, John
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Cardiovascular Society 01.11.2010; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: 80 and over; Adult; Aged; Aged, 80 and over; Angioplasty; Angioplasty, Balloon, Coronary - adverse effects; Angioplasty, Balloon, Coronary - methods; Balloon; Biological and medical sciences; Biomarkers - blood; Cardiac and Cardiovascular Systems; Cardiology. Vascular system; Clinical Medicine; coronary artery disease (CAD); Coronary heart disease; coronary intervention; Coronary/adverse effects/methods; Creatine Kinase; Creatine Kinase, MB Form - blood; Electrocardiography; Female; Heart; Heart attacks; Humans; Ischemic Preconditioning; Ischemic Preconditioning, Myocardial - methods; Kardiologi; Kinases; Klinisk medicin; Magnetic Resonance Imaging - methods; Male; MB Form/blood; Medical and Health Sciences; Medical sciences; Medicin och hälsovetenskap; Middle Aged; MRI; Myocardial infarction; Myocardial Infarction - pathology; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Myocardial Infarction/pathology/physiopathology/therapy; Myocardial Reperfusion Injury - etiology; Myocardial Reperfusion Injury - prevention & control; Myocardial Reperfusion Injury/etiology/prevention & control; Myocardial/methods; Myocarditis. Cardiomyopathies; postconditioning; Prospective Studies; reperfusion injury; Rodents; STEMI; Stroke Volume; Studies; Troponin T - blood; Human; Myocardial infarction; ST elevation; Size; Cardiovascular disease; Patient; Circulatory system; Cardiology; Coronary heart disease; Myocardial disease
• ISSN: 1355-6037; 1468-201X; 1468-201X
• DOI: 10.1136/hrt.2010.199430

BackgroundSmall studies suggest that postconditioning reperfusion interrupted by brief repetitive cycles of reocclusions, may protect the myocardium in the clinical setting.ObjectiveTo test the hypothesis that postconditioning limits infarct size in relation to the area at risk in patients with ST elevation myocardial infarction (STEMI).Methods76 patients (aged 37–87 years) eligible for primary percutaneous coronary intervention due to STEMI were randomised to standard percutaneous coronary intervention (n=38) or postconditioning, consisting of four cycles of 60 s reperfusion and 60 s of reocclusion before permanent reperfusion (n=38).ResultsThe area at risk was determined from angiographic abnormally contracting segments. Infarct size was quantified from delayed enhancement MRI on days 6–9. Infarct size, expressed in relation to the area at risk, did not differ between the control group (44%; 30, 56) (median and quartiles) and the post-conditioned group (47%; 23, 63). The slope of the regression lines relating infarct size to the area at risk differed between the two groups. Infarct size was significantly (p=0.001) reduced by postconditioning in patients with large areas at risk. The area under the curve and peak troponin T release and CKMB during 48 h did not differ between patients in the control and postconditioning groups.ConclusionsThis prospective, randomised trial suggests that postconditioning does not reduce infarct size in patients with STEMI in the overall study group. The data indicate that postconditioning may be of value in patients with large areas at risk.Clinical trial registration informationKarolinska Clinical Trial Registration (http://www.kctr.se). Unique identifier: CT20080014.