Joo-Yong Hahn1, Cheol Woong Yu2, Hun Sik Park3, Young Bin Song4, Eun Kyoung Kim4, Hyun Jong Lee5, Jang-Whan Bae6, Woo-Young Chung7, Seung-Hyuk Choi4, Jin-Ho Choi4, Jang-Ho Bae8, Kyung Joo An9, Jong-Seon Park10, Ju Hyeon Oh11, Sang-Wook Kim12, Jin-Yong Hwang13, Jae Kean Ryu14, Do-Sun Lim2, Hyeon-Cheol Gwon4. 1. Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address: jyhahn@skku.edu. 2. Korea University Anam Hospital, Seoul, Korea. 3. Kyungpook National University Hospital, Daegu, Korea. Electronic address: hspark@knu.ac.kr. 4. Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 5. Sejong General Hospital, Bucheon, Korea. 6. Chungbuk National University College of Medicine, Cheongju, Korea. 7. Seoul National University Boramae Medical Center, Seoul, Korea. 8. Konyang University Hospital, Daejon, Korea. 9. KEPCO Medical Center, Seoul, Korea. 10. Yeungnam University Hospital, Daegu, Korea. 11. Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea. 12. Chung-Ang University Hospital, Seoul, Korea. 13. Gyeongsang National University Hospital, Jinju, Korea. 14. Daegu Catholic University Medical Center, Daegu, Korea.
Abstract
BACKGROUND: In the Effects of Postconditioning on Myocardial Reperfusion in Patients with ST-segment Elevation Myocardial Infarction (POST) trial, ischemic postconditioning failed to improve myocardial reperfusion. However, long-term effects of ischemic postconditioning on clinical outcomes are not known in patients with ST-segment elevation myocardial infarction. METHODS: A total of 700 patients undergoing primary percutaneous coronary intervention (PCI) were randomly assigned to the postconditioning group or the conventional primary PCI group in a 1:1 ratio. Postconditioning was performed immediately after restoration of coronary flow by balloon occlusion 4 times for 1 minute. Complete follow-up data for major clinical events at 1 year were available in 695 patients (99.3%), and analyses were done by the intention to treat principle. The primary outcome was a composite of death, myocardial infarction, severe heart failure, or stent thrombosis at 1 year. RESULTS: At 1 year, a composite of death, myocardial infarction, severe heart failure, or stent thrombosis occurred in 21 patients (6.1%) in the postconditioning group and 16 patients (4.6%) in the conventional PCI group (hazard ratio [HR] 1.32, 95% CI 0.69-2.53, P = .40). The risk of death (4.9% vs 3.7%, HR 1.32, 95% CI 0.64-2.71, P = .46), heart failure (2.6% vs 2.3%, HR 1.13, 95% CI 0.44-2.94, P = .80), and stent thrombosis (2.3% vs 1.7%, HR 1.34, 95% CI 0.46-3.85, P = .59) did not differ significantly between the 2 groups. CONCLUSIONS:Ischemic postconditioning does not seem to improve the 1-year clinical outcomes in patients with ST-segment elevation myocardial infarction undergoing primary PCI.
RCT Entities:
BACKGROUND: In the Effects of Postconditioning on Myocardial Reperfusion in Patients with ST-segment Elevation Myocardial Infarction (POST) trial, ischemic postconditioning failed to improve myocardial reperfusion. However, long-term effects of ischemic postconditioning on clinical outcomes are not known in patients with ST-segment elevation myocardial infarction. METHODS: A total of 700 patients undergoing primary percutaneous coronary intervention (PCI) were randomly assigned to the postconditioning group or the conventional primary PCI group in a 1:1 ratio. Postconditioning was performed immediately after restoration of coronary flow by balloon occlusion 4 times for 1 minute. Complete follow-up data for major clinical events at 1 year were available in 695 patients (99.3%), and analyses were done by the intention to treat principle. The primary outcome was a composite of death, myocardial infarction, severe heart failure, or stent thrombosis at 1 year. RESULTS: At 1 year, a composite of death, myocardial infarction, severe heart failure, or stent thrombosis occurred in 21 patients (6.1%) in the postconditioning group and 16 patients (4.6%) in the conventional PCI group (hazard ratio [HR] 1.32, 95% CI 0.69-2.53, P = .40). The risk of death (4.9% vs 3.7%, HR 1.32, 95% CI 0.64-2.71, P = .46), heart failure (2.6% vs 2.3%, HR 1.13, 95% CI 0.44-2.94, P = .80), and stent thrombosis (2.3% vs 1.7%, HR 1.34, 95% CI 0.46-3.85, P = .59) did not differ significantly between the 2 groups. CONCLUSIONS:Ischemic postconditioning does not seem to improve the 1-year clinical outcomes in patients with ST-segment elevation myocardial infarction undergoing primary PCI.
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Authors: Tamás Baranyai; Zoltán Giricz; Zoltán V Varga; Gábor Koncsos; Dominika Lukovic; András Makkos; Márta Sárközy; Noémi Pávó; András Jakab; Csilla Czimbalmos; Hajnalka Vágó; Zoltán Ruzsa; Levente Tóth; Rita Garamvölgyi; Béla Merkely; Rainer Schulz; Mariann Gyöngyösi; Péter Ferdinandy Journal: J Transl Med Date: 2017-04-01 Impact factor: 5.531