1. Effect of Ischemic Postconditioning During Primary Percutaneous Coronary Intervention for Patients With ST-Segment Elevation Myocardial Infarction:A Randomized Clinical Trial
- Author
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Engstrøm, Thomas, Kelbæk, Henning, Helqvist, Steffen, Høfsten, Dan Eik, Kløvgaard, Lene, Clemmensen, Peter, Holmvang, Lene, Jørgensen, Erik, Pedersen, Frants, Saunamaki, Kari, Ravkilde, Jan, Tilsted, Hans Henrik, Villadsen, Anton, Aarøe, Jens, Jensen, Svend Eggert, Raungaard, Bent, Bøtker, Hans E., Terkelsen, Christian J., Maeng, Michael, Kaltoft, Anne, Krusell, Lars R., Jensen, Lisette O., Veien, Karsten T., Kofoed, Klaus Fuglsang, Torp-Pedersen, Christian, Kyhl, Kasper, Nepper-Christensen, Lars, Treiman, Marek, Vejlstrup, Niels, Ahtarovski, Kiril, Lønborg, Jacob, Køber, Lars, Thygesen, Kristian, Jeppesen, Jørgen, Galløe, Anders, Jensen, Gorm Boje, Gislasson, Gunnar, and Erlinge, David
- Subjects
0301 basic medicine ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Denmark ,Infarction ,030204 cardiovascular system & hematology ,ST Elevation Myocardial Infarction/therapy ,03 medical and health sciences ,0302 clinical medicine ,Reperfusion therapy ,Percutaneous Coronary Intervention ,Internal medicine ,Cause of Death ,medicine ,Journal Article ,Humans ,cardiovascular diseases ,Myocardial infarction ,Mortality ,Ischemic Postconditioning ,Original Investigation ,Hospitalization/statistics & numerical data ,Aged ,Proportional Hazards Models ,Percutaneous Coronary Intervention/methods ,Heart Failure ,business.industry ,Myocardium ,Stent ,Percutaneous coronary intervention ,Middle Aged ,medicine.disease ,Coronary Vessels ,Hospitalization ,030104 developmental biology ,Treatment Outcome ,Editorial ,Heart failure ,Conventional PCI ,Cardiology ,ST Elevation Myocardial Infarction ,Female ,Stents ,Heart Failure/epidemiology ,Cardiology and Cardiovascular Medicine ,business ,TIMI ,Ischemic Postconditioning/methods - 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.
- Published
- 2017