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Updated: Apr 12, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Long-term effects of ischemic postconditioning on clinical outcomes: 1-year follow-up of the POST randomized trial
Joo-Yong Hahn1, Cheol Woong Yu2, Hun Sik Park3
1Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Insights
Ischemic postconditioning did not improve 1-year clinical outcomes for ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. This study found no significant difference in major adverse events between postconditioning and conventional PCI groups.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Ischemic postconditioning has not demonstrably improved myocardial reperfusion in ST-segment elevation myocardial infarction (STEMI) patients.
- Long-term clinical outcome data following ischemic postconditioning in STEMI patients are limited.
Purpose of the Study:
- To evaluate the long-term (1-year) clinical outcomes of ischemic postconditioning in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI).
Main Methods:
- A randomized controlled trial involving 700 patients undergoing primary PCI, assigned 1:1 to postconditioning or conventional PCI.
- Postconditioning involved brief balloon occlusions immediately after coronary flow restoration.
- The primary outcome was a composite of death, myocardial infarction, severe heart failure, or stent thrombosis at 1 year, analyzed by intention-to-treat.
Main Results:
- No significant difference in the composite outcome (6.1% vs 4.6%, P=.40) between the postconditioning and conventional PCI groups at 1 year.
- Individual event rates for death, heart failure, and stent thrombosis also showed no significant differences between the groups.
- Hazard ratios for the composite outcome and individual events were not statistically significant.
Conclusions:
- Ischemic postconditioning does not appear to enhance 1-year clinical outcomes in STEMI patients undergoing primary PCI.
- The findings suggest that ischemic postconditioning is not beneficial for reducing major adverse clinical events in this patient population.
Background:
In the Effects of Postconditioning on Myocardial Reperfusion in Patients with ST-segment Elevation Myocardial Infarction (POST) trial, ischemic postconditioning failed to improve myocardial reperfusion. However, long-term effects of ischemic postconditioning on clinical outcomes are not known in patients with ST-segment elevation myocardial infarction.
Methods:
A total of 700 patients undergoing primary percutaneous coronary intervention (PCI) were randomly assigned to the postconditioning group or the conventional primary PCI group in a 1:1 ratio. Postconditioning was performed immediately after restoration of coronary flow by balloon occlusion 4 times for 1 minute. Complete follow-up data for major clinical events at 1 year were available in 695 patients (99.3%), and analyses were done by the intention to treat principle. The primary outcome was a composite of death, myocardial infarction, severe heart failure, or stent thrombosis at 1 year.
Results:
At 1 year, a composite of death, myocardial infarction, severe heart failure, or stent thrombosis occurred in 21 patients (6.1%) in the postconditioning group and 16 patients (4.6%) in the conventional PCI group (hazard ratio [HR] 1.32, 95% CI 0.69-2.53, P = .40). The risk of death (4.9% vs 3.7%, HR 1.32, 95% CI 0.64-2.71, P = .46), heart failure (2.6% vs 2.3%, HR 1.13, 95% CI 0.44-2.94, P = .80), and stent thrombosis (2.3% vs 1.7%, HR 1.34, 95% CI 0.46-3.85, P = .59) did not differ significantly between the 2 groups.
Conclusions:
Ischemic postconditioning does not seem to improve the 1-year clinical outcomes in patients with ST-segment elevation myocardial infarction undergoing primary PCI.
