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

  • Santiago Garcia
  • Timothy D. Henry
  • Yale L. Wang
  • Ivan J. Chavez
  • Wesley R. Pedersen
  • John R. Lesser
  • Gautam R. Shroff
  • Luke Moore
  • Jay H. Traverse
Article

DOI: 10.1007/s12265-010-9252-0

Cite this article as:
Garcia, S., Henry, T.D., Wang, Y.L. et al. J. of Cardiovasc. Trans. Res. (2011) 4: 92. doi:10.1007/s12265-010-9252-0

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.

Keywords

Acute myocardial infarction Postconditioning Cardioprotection 

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Santiago Garcia
    • 1
    • 3
  • Timothy D. Henry
    • 2
    • 3
  • Yale L. Wang
    • 2
  • Ivan J. Chavez
    • 2
  • Wesley R. Pedersen
    • 2
  • John R. Lesser
    • 2
  • Gautam R. Shroff
    • 3
    • 4
  • Luke Moore
    • 2
  • Jay H. Traverse
    • 2
    • 3
  1. 1.Minneapolis VA Medical CenterMinneapolisUSA
  2. 2.Minneapolis Heart Institute FoundationAbbott Northwestern HospitalMinneapolisUSA
  3. 3.University of Minnesota Medical SchoolMinneapolisUSA
  4. 4.Hennepin County Medical CenterMinneapolisUSA

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