Effect and Role of Post-conditioning During Coronary Angioplasty in Patients Affected by ST-Elevation Acute Myocardial Infarction
Year: 2012
Type: dissertation
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: Background Reperfusion is the mainstay treatment for patients presenting with ST-elevation myocardial infarction (STEMI). Nevertheless, reperfusion itself may exacerbate myocardial injury, a process termed “reperfusion injury”. Post-conditioning (PostC) has been suggested to reduce myocardial damage during primary percutaneous coronary intervention (PPCI), nevertheless clinical experience is limited. Objectives We aimed to review all the known strategies to limit the reperfusion injury; moreover we explored the cardioprotective effect of mechanical postconditioning conducting a randomized trial aimed to evalutate infarct size (IS) at cardiac magnetic resonance (CMR) in STEMI patients treated by PPCI. Methods A total of 78 patients with first STEMI (aged 59±12 years) referred for PPCI, were stratified for STEMI location and randomly assigned to conventional PPCI or PPCI with PostC. All patients, with occluded infarct related artery and no collateral circulation, received abciximab intravenously before PPCI. After reperfusion by effective direct stenting, control subjects underwent no further intervention, while in treated patients PostC was performed within 1 minute of reflow by 4 cycles of 1-minute inflation and 1-minute deflation of the angioplasty balloon. Primary end-point was IS reduction, expressed as percentage of left ventricle mass assessed by delayed enhancement on CMR at 30±10 days after index PPCI. Results All baseline characteristics but diabetes (p=0.06) were balanced between groups. Postconditioning patients trended towards a larger IS compared to those treated by standard PPCI (20±12% vs 14±10%, p=0.054). After exclusion of diabetics, PostC group still showed a trend to larger IS (p=0.116). Major adverse events seem to be more frequent in PostC group irrespective to diabetes status (p=0.053 and p=0.080, respectively). Conclusions This prospective, randomized trial suggests that PostC did not have the expected cardioprotective effect and, on the contrary, it might harm STEMI patients treated by PPCI plus abciximab. (Clinical Trial Registration-unique identifier: NCT01004289).
Author: Enrico Favaretto
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2287851424