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Effect of postconditioning on infarct size in patients with ST elevation myocardial infarction

Journal article
Authors P. Sorensson
N. Saleh
F. Bouvier
F. Bohm
M. Settergren
Kenneth Caidahl
P. Tornvall
H. Arheden
L. Ryden
J. Pernow
Published in Heart
Volume 96
Issue 21
Pages 1710-5
ISSN 1355-6037
Publication year 2010
Published at Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 1710-5
Language en
Links dx.doi.org/10.1136/hrt.2010.199430
Keywords Adult, Aged, Aged, 80 and over, Angioplasty, Balloon, Coronary/adverse effects/*methods, Biomarkers/blood, Creatine Kinase, MB Form/blood, Electrocardiography, Female, Humans, Ischemic Preconditioning, Myocardial/*methods, Magnetic Resonance Imaging/methods, Male, Middle Aged, Myocardial Infarction/pathology/physiopathology/*therapy, Myocardial Reperfusion Injury/etiology/*prevention & control, Prospective Studies, Stroke Volume, Troponin T/blood
Subject categories Cardiovascular medicine

Abstract

BACKGROUND: Small studies suggest that postconditioning reperfusion interrupted by brief repetitive cycles of reocclusions, may protect the myocardium in the clinical setting. OBJECTIVE: To test the hypothesis that postconditioning limits infarct size in relation to the area at risk in patients with ST elevation myocardial infarction (STEMI). METHODS: 76 patients (aged 37-87 years) eligible for primary percutaneous coronary intervention due to STEMI were randomised to standard percutaneous coronary intervention (n = 38) or postconditioning, consisting of four cycles of 60 s reperfusion and 60 s of reocclusion before permanent reperfusion (n = 38). RESULTS: The area at risk was determined from angiographic abnormally contracting segments. Infarct size was quantified from delayed enhancement MRI on days 6-9. Infarct size, expressed in relation to the area at risk, did not differ between the control group (44%; 30, 56) (median and quartiles) and the post-conditioned group (47%; 23, 63). The slope of the regression lines relating infarct size to the area at risk differed between the two groups. Infarct size was significantly (p = 0.001) reduced by postconditioning in patients with large areas at risk. The area under the curve and peak troponin T release and CKMB during 48 h did not differ between patients in the control and postconditioning groups. CONCLUSIONS: This prospective, randomised trial suggests that postconditioning does not reduce infarct size in patients with STEMI in the overall study group. The data indicate that postconditioning may be of value in patients with large areas at risk. Clinical trial registration information Karolinska Clinical Trial Registration (http://www.kctr.se). Unique identifier: CT20080014.

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