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Long-term Follow-up of Patients Undergoing Postconditioning During ST-Elevation Myocardial Infarction

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Abstract

Reperfusion injury may offset the optimal salvage of myocardium achieved during primary coronary angioplasty. Thus, coronary reperfusion must be combined with cardioprotective adjunctive therapies in order to optimize myocardial salvage and minimize infarct size. Forty-three patients with their first ST-elevation myocardial infarction were randomized to myocardial postconditioning or standard of care at the time of primary coronary angioplasty. Postconditioning was performed immediately upon crossing the lesion with the guide wire and consisted of four cycles of 30 s occlusion followed by 30 s of reperfusion. End-points included infarct size, myocardial perfusion grade (MPG), left-ventricular ejection fraction (LVEF), and long-term clinical events (death and heart failure). Despite similar ischemic times (≅4.5 h) (p = 0.9) a reduction in infarct size was observed among patients treated with the postconditioning protocol. Peak creatine phosphokinase (CPK), as well as its myocardial band (MB) fraction, was significantly lower in the postconditioning group when compared with the control group (CPK—control, 2,444 ± 1,928 IU/L vs. PC, 2,182 ± 1,717 IU/L; CPK-MB—control, 242 ± 40 IU/L vs. PC, 195 ± 33 IU/L; p = 0.64 and p < 0.01, respectively). EF in the postconditioning group was improved when compared with the control group (control, 43% ± 15 vs. PC, 52% ± 9; p = 0.05). After a mean follow-up of 3.4 years, a 6-point absolute difference in LVEF was still evident in the postconditioning group (p = 0.18). MPG was better among patients treated with the postconditioning protocol compared with control (2.5 ± 0.5 vs. 2.1 ± 0.6; p = 0.02). Due to the small sample size no significant differences in clinical events were detected (p value for death = 0.9; p value for heart failure = 0.2). A simple postconditioning protocol applied at the onset of mechanical reperfusion, resulted in reduction of infarct size, better epicardial and myocardial flow, and improvement in left ventricular function. The beneficial effects of postconditioning on cardiac function persist beyond 3 years.

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Acknowledgments

The authors are grateful to Beth Jorgenson, RN and Noel Bennett who helped with data collection.

Disclosures

Dr. Garcia received grant support from Cordis (Miami Lakes, FL) and the Society for Cardiac Angiography and Interventions (SCAI) to study myocardial postconditioning.

Conflicts of Interest

No other conflicts of interest to disclose.

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Authors and Affiliations

  1. Minneapolis VA Medical Center, Minneapolis, MN, USA

    Santiago Garcia

  2. Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, 920 East 28th Street, Suite 300, Minneapolis, MN, 55407, USA

    Timothy D. Henry, Yale L. Wang, Ivan J. Chavez, Wesley R. Pedersen, John R. Lesser, Luke Moore & Jay H. Traverse

  3. University of Minnesota Medical School, Minneapolis, MN, USA

    Santiago Garcia, Timothy D. Henry, Gautam R. Shroff & Jay H. Traverse

  4. Hennepin County Medical Center, Minneapolis, MN, USA

    Gautam R. Shroff

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  1. Santiago Garcia
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Correspondence to Jay H. Traverse.

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Garcia, S., Henry, T.D., Wang, Y.L. et al. Long-term Follow-up of Patients Undergoing Postconditioning During ST-Elevation Myocardial Infarction. J. of Cardiovasc. Trans. Res. 4, 92–98 (2011). https://doi.org/10.1007/s12265-010-9252-0

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