0057: Ischemic postconditioning reduces infarct size: systematic review and meta-analysis of randomized controlled trials

Touboul, Caroline; Angoulvant, Denis; Mewton, Nathan; Ivanès, Fabrice; Muntean, Danina; Prunier, Fabrice; Ovize, Michel; Angoulvant, T.

doi:10.1016/s1878-6480(15)71517-x

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“…Initial positive trials using bone marrow mononuclear cells and subsequent positive meta-analyses give way to larger trials using cMRI imaging that were neutral despite a similar patient population (26,34). Although recent meta-analyses (35) suggest a clinical benefit of PostC in reducing infarct size by serial cardiac enzymes, many subsequent larger trials using advanced cMRI imaging such as ours, have found no acute benefit of this intervention. Similar to cell therapy, the failure of the PostC studies to define basic methodology such as the optimum PostC algorithm and other factors such as the role of direct stenting, aspiration thrombectomy and the duration of index ischemia that is most responsive to PostC (36,37) remain a major limitation.…”

Section: Is There a Role For Postconditioning In Stemi?mentioning

confidence: 87%

NHLBI-Sponsored Randomized Trial of Postconditioning During Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction

Traverse

Swingen

Henry

et al. 2019

Circulation Research

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Rationale: Postconditioning (PostC) at the time of primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) may reduce infarct size and improve myocardial salvage. However, clinical trials have shown inconsistent benefit. Objective: We performed the first NHLBI-sponsored trial of PostC in the United States utilizing strict enrollment criteria to optimize the early benefits of PostC and assess its long-term effects on LV function. Methods and Results: We randomized 122 STEMI patients to PostC (Four, 30-sec. PTCA inflations / deflations) + PCI(n=65) vs. routine PCI (n=57). All subjects had an occluded major epicardial artery (TIMI= 0) with ischemic times between 1 and 6 hours with no evidence of preinfarction angina or collateral blood flow. Cardiac MRI measured at 2 days post-PCI showed no difference between the PostC group and Control in regards to infarct size (22.5 ± 14.5 g vs. 24.0 ± 18.5 g), myocardial salvage index (MSI) (30.3 ± 15.6% vs. 31.5 ± 23.6%) or mean LVEF. MRI at 12-months showed a significant recovery of LVEF in both groups (61.0 ± 11.4% and 61.4± 9.1%; p < 0.01). Subjects randomized to PostC experienced more favorable remodeling over 1 year (LVEDV = 157 ± 34 to 150 ± 38 ml) compared to the Control group (157 ± 40 to 165 ± 45 ml) (p < 0.03) and reduced microvascular obstruction (MVO) (p=0.05) on baseline MRI and significantly less adverse LV remodeling compared to Control subjects with MVO (p < 0.05). No significant adverse events were associated with the PostC protocol and all patients but one (hemorrhagic stroke) survived thru one-year of follow-up. Conclusions: We found no early benefit of PostC on infarct size, MSI and LV function compared to routine PCI. However, PostC was associated with improved LV remodeling at one year of follow-up, especially in subjects with MVO.

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Section: Is There a Role For Postconditioning In Stemi?mentioning

confidence: 87%