Design and Methodologies of the POSTconditioning during Coronary Angioplasty in Acute Myocardial Infarction (POST-AMI) Trial

Abstract

Background: Reperfusion remains the definitive treatment for acute myocardial infarction (AMI), but restoring blood flow carries the potential to exacerbate the ischemia-related injury. Postconditioning might modify reperfusion-induced adverse events. Study Design: The POSTconditioning during Coronary Angioplasty in Acute Myocardial Infarction (POST-AMI) trial is a single-center, prospective, randomized study, with a planned inclusion of 78 patients with ST-elevation AMI. Patients will be randomly assigned to the postconditioning arm [primary angioplasty (PA) and stenting followed by brief episodes of ischemia-reperfusion early after recanalization] or non-postconditioning arm. All patients will be treated medically according to current international guidelines, including glycoprotein IIb/IIIa inhibitors before PA. The primary end point is to evaluate whether postconditioning, compared to plain PA, reduces infarct size estimated by cardiac magnetic resonance (CMR) at 30 ± 10 days after the AMI. Secondary end points are microvascular obstruction observed at CMR, ST-segment resolution, angiographic myocardial blush grade <2, non-sustained/sustained ventricular tachycardia in the 48 h following PA, left ventricular remodeling and function at follow-up CMR, and the reduction of major adverse cardiac events at 30 days and 6 months. Conclusion: The POST-AMI trial will evaluate the usefulness of postconditioning in limiting infarct size during the early and late phases after AMI.

Postconditioning during coronary angioplasty in acute myocardial infarction: the POST-AMI trial

“…The design of this study has been described previously [12]. Briefly, patients were eligible for enrollment if they were aged >18 years and had clinical evidence of STEMI with time interval from symptom onset of less than 6 h before hospital admission, and occlusion of the infarct-related artery (TIMI flow grade ≤1).…”

Cardioprotection From Ischemia/Reperfusion Injury

“…39 Prospective and randomized studies are now ongoing to evaluate the infarctsize-limiting effects of ischemic postconditioning in patients with ST-segment elevation myocardial infarction (STEMI) who are undergoing primary PCI. 40, 41 Coronary blood flow must be interrupted in order to apply ischemic postconditioning, which increases the time required for the procedure and could potentially cause atherosclerotic emboli. Pharmacological manipulation of autacoids, their receptors, kinase signaling pathways and modulation of the mPTP opening, all of which are involved in ischemic postconditioning, could be easily utilized to treat patients with AMI undergoing primary PCI (Table 1).…”

Ischemic Postconditioning with Lactate-Enriched Blood in Patients with Acute Myocardial Infarction

“…Limalanathan et al [1] and Tarantini et al [2] reported study designs for examining the protective effects of postconditioning in patients with acute myocardial infarction (MI) in volume 116 of Cardiology in 2010. However, recent clinical trials have not elucidated the protective effects of postconditioning [3,4].…”