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Effect of Ischemic Postconditioning During Primary Percutaneous Coronary Intervention for Patients With ST-Segment Elevation Myocardial Infarction: A Randomized Clinical Trial.


ABSTRACT: Importance: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. Objective:To determine whether ischemic postconditioning can improve the clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Design, Setting, And Participants: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. Interventions: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. Main Outcome and Measures:A combination of all-cause death and hospitalization for heart failure. Results: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. Conclusions and Relevance:Routine ischemic postconditioning during primary PCI failed to reduce the composite outcome of death from any cause and hospitalization for heart failure in patients with STEMI and TIMI grade 0-1 flow at arrival. Trial Registration:clinicaltrials.gov Identifier: NCT01435408.

SUBMITTER: Engstrom T 

PROVIDER: S-EPMC5814983 | biostudies-literature | 2017 May

REPOSITORIES: biostudies-literature

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Effect of Ischemic Postconditioning During Primary Percutaneous Coronary Intervention for Patients With ST-Segment Elevation Myocardial Infarction: A Randomized Clinical Trial.

Engstrøm Thomas T   Kelbæk Henning H   Helqvist Steffen S   Høfsten Dan Eik DE   Kløvgaard Lene L   Clemmensen Peter P   Holmvang Lene L   Jørgensen Erik E   Pedersen Frants F   Saunamaki Kari K   Ravkilde Jan J   Tilsted Hans-Henrik HH   Villadsen Anton A   Aarøe Jens J   Jensen Svend Eggert SE   Raungaard Bent B   Bøtker Hans E HE   Terkelsen Christian J CJ   Maeng Michael M   Kaltoft Anne A   Krusell Lars R LR   Jensen Lisette O LO   Veien Karsten T KT   Kofoed Klaus Fuglsang KF   Torp-Pedersen Christian C   Kyhl Kasper K   Nepper-Christensen Lars L   Treiman Marek M   Vejlstrup Niels N   Ahtarovski Kiril K   Lønborg Jacob J   Køber Lars L  

JAMA cardiology 20170501 5


<h4>Importance</h4>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.<h4>Objective</h4>To determine whether ischemic postconditioning can improve the clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI).<h4>Design, setting, and participants</h4>In this  ...[more]

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