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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Effect of Ischemic Postconditioning During Primary Percutaneous Coronary Intervention for Patients With ST-Segment
Thomas Engstrøm1, Henning Kelbæk2, Steffen Helqvist1
1Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Insights
Ischemic postconditioning during primary percutaneous coronary intervention did not significantly reduce major adverse cardiovascular events in ST-segment elevation myocardial infarction patients. This study found no benefit for this technique in improving clinical outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Myocardial Infarction Research
Background:
- Ischemic postconditioning is a potential strategy to limit myocardial damage after reperfusion injury.
- Its efficacy in improving clinical outcomes in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) requires robust clinical validation.
Purpose of the Study:
- To evaluate the effectiveness of ischemic postconditioning in reducing major adverse cardiovascular events in STEMI patients.
- To determine if postconditioning improves clinical outcomes compared to conventional primary PCI.
Main Methods:
- A multicenter, randomized clinical trial involving 1234 STEMI patients with TIMI grade 0-1 flow.
- Patients were randomized to conventional primary PCI or PCI with ischemic postconditioning (4 cycles of 30-second balloon occlusion/reperfusion).
- Primary outcome was a composite of all-cause death and hospitalization for heart failure, with a median follow-up of 38 months.
Main Results:
- The primary composite outcome occurred in 11.2% of patients in the conventional PCI group and 10.5% in the postconditioning group (HR, 0.93; 95% CI, 0.66-1.30; P=.66).
- No significant differences were observed for all-cause death (HR, 0.75; 95% CI, 0.49-1.14; P=.18) or heart failure hospitalization (HR, 0.99; 95% CI, 0.60-1.64; P=.96).
Conclusions:
- Routine ischemic postconditioning during primary PCI does not reduce the composite outcome of death or heart failure hospitalization in STEMI patients.
- The findings suggest that current postconditioning protocols may not offer significant clinical benefits in this patient population.
Importance:
Ischemic postconditioning of the heart during primary percutaneous coronary intervention (PCI) induced by repetitive interruptions of blood flow to the ischemic myocardial region immediately after reopening of the infarct-related artery may limit myocardial damage.
Objective:
To determine whether ischemic postconditioning can improve the clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI).
Design, Setting, And Participants:
In this multicenter, randomized clinical trial, patients with onset of symptoms within 12 hours, STEMI, and thrombolysis in myocardial infarction (TIMI) grade 0-1 flow in the infarct-related artery at arrival were randomized to conventional PCI or postconditioning. Inclusion began on March 21, 2011, through February 2, 2014, and follow-up was completed on February 2, 2016. Analysis was based on intention to treat.
Interventions:
Patients were randomly allocated 1:1 to conventional primary PCI, including stent implantation, or postconditioning performed as 4 repeated 30-second balloon occlusions followed by 30 seconds of reperfusion immediately after opening of the infarct-related artery and before stent implantation.
Main Outcome And Measures:
A combination of all-cause death and hospitalization for heart failure.
Results:
During the inclusion period, 1234 patients (975 men [79.0%] and 259 women [21.0%]; mean [SD] age, 62 [11] years) underwent randomization in the trial. Median follow-up was 38 months (interquartile range, 24-58 months). The primary outcome occurred in 69 patients (11.2%) who underwent conventional primary PCI and in 65 (10.5%) who underwent postconditioning (hazard ratio, 0.93; 95% CI, 0.66-1.30; P = .66). The hazard ratios were 0.75 (95% CI, 0.49-1.14; P = .18) for all-cause death and 0.99 (95% CI, 0.60-1.64; P = .96) for heart failure.
Conclusions And Relevance:
Routine ischemic postconditioning during primary PCI failed to reduce the composite outcome of death from any cause and hospitalization for heart failure in patients with STEMI and TIMI grade 0-1 flow at arrival.
Trial Registration:
clinicaltrials.gov Identifier: NCT01435408.
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