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

Title
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
Author(s)
박종선한주영[한주영]송영빈[송영빈]김은경[김은경]유철웅[유철웅]배장환[배장환]정우영[정우영]최승혁[최승혁]최진호[최진호]배장호[배장호]안경주[안경주]오주현[오주현]김상욱[김상욱]환진용[환진용]류재근[류재근]박헌식[박헌식]임도선[임도선]권현철[권현철]
Keywords
MITOCHONDRIAL PERMEABILITY TRANSITION; PROGNOSTIC-SIGNIFICANCE; PRIMARY ANGIOPLASTY; HUMAN HEART; INJURY; SIZE; RESOLUTION; FLOW
Issue Date
201310
Publisher
LIPPINCOTT WILLIAMS & WILKINS
Citation
CIRCULATION, v.128, no.17, pp.1889 - 1896
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.
URI
http://hdl.handle.net/YU.REPOSITORY/28800http://dx.doi.org/10.1161/CIRCULATIONAHA.113.001690
ISSN
0009-7322
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의과대학 > 내과학교실 > Articles
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