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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Ischemic postconditioning during primary percutaneous coronary intervention: the effects of postconditioning on
Joo-Yong Hahn1, Young Bin Song, Eun Kyoung Kim
1Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-Y. Hahn; Y.B.S., E.K.K., S.-H.C., J.-H.C., H.-C.G.); Sejong General Hospital, Bucheon, Korea (C.W.Y.); Chungbuk National University Hospital, Cheongju, Korea (J.-W.B.); Seoul National University, Boramae Medical Center, Seoul, Korea (W.-Y.C.); Konyang University Hospital, Daejon, Korea (J.-H.B.); KEPCO Medical Center, Seoul, Korea (K.J.A.); Yeungnam University Hospital, Daegu, Korea (J.-S.P.); Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea (J.H.O.); Chung-Ang University Hospital, Seoul, Korea (S.-W.K.); Gyeongsang National University Hospital, Jinju, Korea (J.-Y. Hwang); Daegu Catholic University Medical Center, Daegu, Korea (J.K.R.); Kyungpook National University Hospital, Daegu, Korea (H.S.P.); and Korea University Anam Hospital, Seoul, Korea (D.-S.L.).
Insights
Ischemic postconditioning did not improve ST-segment resolution or reperfusion in ST-segment-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. This large-scale trial found no significant benefit compared to conventional treatment.
Area of Science:
- Cardiology
- Interventional Cardiology
- Ischemic Heart Disease
Background:
- Ischemic postconditioning shows promise for reducing infarct size in ST-segment-elevation myocardial infarction (STEMI).
- Previous studies suggest cardioprotective effects, but large-scale trial data are lacking.
Purpose of the Study:
- To evaluate the efficacy of ischemic postconditioning in improving myocardial reperfusion in STEMI patients undergoing primary percutaneous coronary intervention (PCI).
Main Methods:
- A multicenter, prospective, randomized, open-label trial involving 700 STEMI patients within 12 hours of symptom onset.
- Patients were assigned to either postconditioning or conventional primary PCI.
- Postconditioning involved brief balloon inflations after coronary flow restoration.
Main Results:
- Complete ST-segment resolution at 30 minutes occurred in 40.5% of the postconditioning group vs. 41.5% of the conventional PCI group (P=0.79).
- No significant differences were observed in myocardial blush grade or 30-day major adverse cardiac events between groups.
- Rates of complete ST-segment resolution were similar, indicating no improvement with postconditioning.
Conclusions:
- Ischemic postconditioning did not enhance myocardial reperfusion in STEMI patients undergoing primary PCI.
- The findings suggest that postconditioning offers no significant benefit over current standard PCI practices for this patient population.
Background:
Ischemic postconditioning has been reported to reduce infarct size in patients with ST-segment-elevation myocardial infarction. However, cardioprotective effects of postconditioning have not been demonstrated in a large-scale trial.
Methods And Results:
We performed a multicenter, prospective, randomized, open-label, blinded end-point trial. A total of 700 patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment-elevation myocardial infarction within 12 hours after symptom onset were randomly assigned to the postconditioning group or to the conventional primary PCI group in a 1:1 ratio. Postconditioning was performed immediately after restoration of coronary flow as follows: The angioplasty balloon was positioned at the culprit lesion and inflated 4 times for 1 minute with low-pressure (<6 atm) inflations, each separated by 1 minute of deflation. The primary end point was complete ST-segment resolution (percentage resolution of ST-segment elevation >70%) measured at 30 minutes after PCI. Complete ST-segment resolution occurred in 40.5% of patients in the postconditioning group and 41.5% of patients in the conventional PCI group (absolute difference, -1.0%; 95% confidence interval, -8.4 to 6.4; P=0.79). The rate of myocardial blush grade of 0 or 1 and the rate of major adverse cardiac events (a composite of death, myocardial infarction, severe heart failure, or stent thrombosis) at 30 days did not differ significantly between the postconditioning group and the conventional PCI group (17.2% versus 22.4% [P=0.20] and 4.3% versus 3.7% [P=0.70], respectively).
Conclusion:
Ischemic postconditioning did not improve myocardial reperfusion in patients with ST-segment-elevation myocardial infarction undergoing primary PCI with current standard practice.
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