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      Effect of Ischemic Postconditioning on Infarct Size in Patients With ST‐Elevation Myocardial Infarction Treated by Primary PCI Results of the POSTEMI (POstconditioning in ST‐Elevation Myocardial Infarction) Randomized Trial

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          Abstract

          Background

          Reduction of infarct size by ischemic postconditioning (IPost) has been reported in smaller proof‐of‐concept clinical studies, but has not been confirmed in other smaller studies. The principle needs to be evaluated in larger groups of ST‐elevation myocardial infarction (STEMI) patients before being implemented in clinical practice. This study assessed the effect of ischemic postcoditioning (IPost) on infarct size in patients with STEMI treated by primary percutaneous coronary intervention (PCI).

          Methods and Results

          Patients with first‐time STEMI, <6 hours from symptom onset, referred to primary PCI were randomized to IPost or control groups. IPost was administered by 4 cycles of 1‐minute reocclusion and 1‐minute reperfusion, starting 1 minute after opening, followed by stenting. In the control group, stenting was performed immediately after reperfusion. The primary endpoint was infarct size measured by cardiac magnetic resonance after 4 months. A total of 272 patients were randomized. Infarct size (percent of left ventricular mass) after 4 months (median values and interquartile range) was 14.4% (7.7, 24.6) and 13.5% (8.1, 19.3) in the control group and IPost group, respectively ( P=0.18). No significant impact of IPost was found when controlling for baseline risk factors of infarct size in a multivariate linear regression model ( P=0.16). The effects of IPost on secondary endpoints, including markers of necrosis, myocardial salvage, and ejection fraction, as well as adverse cardiac events during follow‐up, were consistently neutral.

          Conclusions

          In contrast to several smaller trials reported previously, we found no significant effects of IPost on infarct size or secondary study outcomes.

          Clinical Trial Registration

          URL: http://www.clinicaltrials.gov Unique identifier: NCT.No.PO1506.

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          Most cited references 10

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          Statistics notes: Analysing controlled trials with baseline and follow up measurements.

           A J Vickers,  D Altman (2001)
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            Changes in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects.

            Transluminal coronary angioplasty can serve as a model for controlled coronary artery occlusion and reperfusion which enables assessment of short-term changes in collateral vessel filling in patients with severe atherosclerotic coronary artery disease. In 16 patients with isolated left anterior descending or right coronary artery disease (greater than or equal to 75% stenosis) and normal left ventricular function, collateral filling to the artery being dilated was visualized by contrast injection into the contralateral artery using a second arterial catheter. During balloon inflation, contralateral dye injection was performed as soon as the patient developed angina or ST-T changes or at 90 seconds in those patients without symptoms or signs of ischemia. Grades of collateral filling from the contralateral vessel were: 0 = none; 1 = filling of side branches of the artery to be dilated via collateral channels without visualization of the epicardial segment; 2 = partial filling of the epicardial segment via collateral channels; 3 = complete filling of the epicardial segment of the artery being dilated via collateral channels. At baseline angiography, nine patients had grade 0 collateral filling, seven had grade 1 and none had grade 2 or 3. During coronary occlusion by balloon inflation, collateral filling improved by one grade in eight patients, two grades in five patients, three grades in two patients and remained the same in one patient.(ABSTRACT TRUNCATED AT 250 WORDS)
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              Postconditioning during coronary angioplasty in acute myocardial infarction: the POST-AMI trial.

              Postconditioning (PC) has been suggested to reduce myocardial damage during primary percutaneous coronary intervention (PPCI), nevertheless clinical experience is limited. We aimed to explore the cardioprotective effect of PC using cardiac magnetic resonance (CMR) in ST-elevation myocardial infarction (STEMI) patients treated by PPCI.
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                Author and article information

                Journal
                J Am Heart Assoc
                J Am Heart Assoc
                ahaoa
                jah3
                Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
                Blackwell Publishing Ltd
                2047-9980
                April 2014
                25 April 2014
                : 3
                : 2
                Affiliations
                [1 ]Center for Heart Failure Research, University of Oslo, Oslo, Norway (S.L., G.A., J.E.)
                [2 ]Center for Clinical Heart Research, Oslo University Hospital Ullevål, Oslo, Norway (G.A., M.A.)
                [3 ]Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway (S.L., G.A., J.E.)
                [4 ]Department of Radiology, Oslo University Hospital Ullevål, Oslo, Norway (N.E.K.)
                [5 ]Unit of Epidemiology and Biostatistics, Oslo University Hospital Ullevål, Oslo, Norway (M.A.)
                [6 ]Section of Interventional Cardiology, Oslo University Hospital Ullevål, Oslo, Norway (P.H.)
                Author notes
                Correspondence to: Shanmuganathan Limalanathan, MD, Department of Cardiology, Oslo University Hospital Ullevål, N‐0407 Oslo, Norway. E‐mail: lisq@ 123456uus.no
                Article
                jah3477
                10.1161/JAHA.113.000679
                4187468
                24760962
                73b4f9fa-8671-4e74-bc4c-5d0ac46964ca
                © 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                Categories
                Original Research
                Interventional Cardiology

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