Ischemic postconditioning during primary percutaneous coronary intervention: The effects of postconditioning on myocardial reperfusion in patients with st-segment elevation myocardial infarction (POST) randomized trial

Joo Yong Hahn, Young Bin Song, Eun Kyoung Kim, Cheol Woong Yu, Jang Whan Bae, Woo Young Chung, Seung Hyuk Choi, Jin Ho Choi, Jang Ho Bae, Kyung Joo An, Jong Seon Park, Ju Hyeon Oh, Sang Wook Kim, Jin Yong Hwang, Jae Kean Ryu, Hun Sik Park, Do Sun Lim, Hyeon Cheol Gwon

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Abstract

BACKGROUND - : Ischemic postconditioning has been reported to reduce infarct size in patients with ST-segment-elevation myocardial infarction. However, cardioprotective effects of postconditioning have not been demonstrated in a large-scale trial. METHODS AND RESULTS - : We performed a multicenter, prospective, randomized, open-label, blinded end-point trial. A total of 700 patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment-elevation myocardial infarction within 12 hours after symptom onset were randomly assigned to the postconditioning group or to the conventional primary PCI group in a 1:1 ratio. Postconditioning was performed immediately after restoration of coronary flow as follows: The angioplasty balloon was positioned at the culprit lesion and inflated 4 times for 1 minute with low-pressure (<6 atm) inflations, each separated by 1 minute of deflation. The primary end point was complete ST-segment resolution (percentage resolution of ST-segment elevation >70%) measured at 30 minutes after PCI. Complete ST-segment resolution occurred in 40.5% of patients in the postconditioning group and 41.5% of patients in the conventional PCI group (absolute difference, -1.0%; 95% confidence interval, -8.4 to 6.4; P=0.79). The rate of myocardial blush grade of 0 or 1 and the rate of major adverse cardiac events (a composite of death, myocardial infarction, severe heart failure, or stent thrombosis) at 30 days did not differ significantly between the postconditioning group and the conventional PCI group (17.2% versus 22.4% [P=0.20] and 4.3% versus 3.7% [P=0.70], respectively). CONCLUSION - : Ischemic postconditioning did not improve myocardial reperfusion in patients with ST-segment-elevation myocardial infarction undergoing primary PCI with current standard practice. CLINICAL TRIAL REGISTRATION - : URL: http://clinicaltrials.gov. Unique identifier: NCT00942500.

Original languageEnglish
Pages (from-to)1889-1896
Number of pages8
JournalCirculation
Volume128
Issue number17
DOIs
Publication statusPublished - 2013 Oct 22

Keywords

  • ischemic postconditioning
  • myocardial infarction
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Hahn, J. Y., Song, Y. B., Kim, E. K., Yu, C. W., Bae, J. W., Chung, W. Y., Choi, S. H., Choi, J. H., Bae, J. H., An, K. J., Park, J. S., Oh, J. H., Kim, S. W., Hwang, J. Y., Ryu, J. K., Park, H. S., Lim, D. S., & Gwon, H. C. (2013). Ischemic postconditioning during primary percutaneous coronary intervention: The effects of postconditioning on myocardial reperfusion in patients with st-segment elevation myocardial infarction (POST) randomized trial. Circulation, 128(17), 1889-1896. https://doi.org/10.1161/CIRCULATIONAHA.113.001690