This multicenter, randomized clinical trial investigates whether ischemic postconditioning of the infarct-related artery vs conventional percutaneous coronary intervention can improve the clinical outcomes of patients with acute onset of ST-segment elevation myocardial infarction.
Does ischemic postconditioning of the heart during primary percutaneous coronary intervention improve clinical outcome?
In a Danish multicenter, randomized clinical trial of 1234 patients with onset of symptoms within 12 hours, ST-segment elevation myocardial infarction, and thrombolysis in myocardial infarction grade 0-1 flow in the infarct-related artery at arrival, all-cause hopitalization or death occurred in 11.2% of 617 patients who underwent percutaneous coronary intervention (including stent implantation) and 10.5% of 617 patients who underwent postconditioning (4 repeated balloon occlusions of 30 seconds followed by 30 seconds of reperfusion immediately after opening of the infarct-related artery and before stent implantation).
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.
To determine whether ischemic postconditioning can improve the clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI).
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.
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.
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.