Ischemic postconditioning obtained through reversible ischemia and reproduced during reperfusion after a prolonged ischemic injury has shown comparable effects to ischemic preconditioning in preclinical phase. A study in humans showed a reduction in serum markers of AMI thanks to Ischemic postconditioning in the context of primary angioplasty. Different MRI studies showed conflicting results regarding the true role of postconditioning.
Methods and Results: Postconditioning was performed through four balloon inflations 1-minute intervals and one minute of rest post-restoration of coronary flow.Primary endpoint was the complete ST reduction rate (> 70%), 30 minutes post-procedure. Secondary endpoints included TIMI flow, myocardial blush and major adverse cardiac events. 700 individuals were randomized referred for primary angioplasty to postconditioning vs conventional treatment. Excluded, among others, patients with cardiogenic shock or injury of the left coronary trunk. Anterior descending artery was responsible for 45% of cases. Baseline TIMI 0 flow was presented in 93% of patients. Complete resolution of ST elevation at 30 min post primary PCI was 40.5 in the postconditioning group vs 41.5% in the control group (p = 0.49). No differences were observed in secondary endpoints.
Conclusions: Implementation of postconditioning during primary angioplasty was not beneficial in the short term, perhaps furthest track define its role during primary angioplasty.
Joo-Yong Hahn
2012-10-25
Original title: A Prospective, Randomized Trial of Post-Conditioning in Patients with ST-Segment Elevation Myocardial Infarction
