TY - JOUR

T1 - Effect of ischemic postconditioning during primary percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction

T2 - A randomized clinical trial

AU - Engstrøm, Thomas

AU - Kelbæk, Henning

AU - Helqvist, Steffen

AU - Høfsten, Dan Eik

AU - Kløvgaard, Lene

AU - Clemmensen, Peter

AU - Holmvang, Lene

AU - Jørgensen, Erik

AU - Pedersen, Frants

AU - Saunamaki, Kari

AU - Ravkilde, Jan

AU - Tilsted, Hans Henrik

AU - Villadsen, Anton

AU - Aarøe, Jens

AU - Jensen, Svend Eggert

AU - Raungaard, Bent

AU - Bøtker, Hans E.

AU - Terkelsen, Christian J.

AU - Maeng, Michael

AU - Kaltoft, Anne

AU - Krusell, Lars R.

AU - Jensen, Lisette O.

AU - Veien, Karsten T.

AU - Kofoed, Klaus Fuglsang

AU - Torp-Pedersen, Christian

AU - Kyhl, Kasper

AU - Nepper-Christensen, Lars

AU - Treiman, Marek

AU - Vejlstrup, Niels

AU - Ahtarovski, Kiril

AU - Lønborg, Jacob

AU - Køber, Lars

AU - Third Danish Study of Optimal Acute Treatment of Patients With ST Elevation Myocardial Infarction-Ischemic Postconditioning (DANAMI-3-iPOST) Investigators

PY - 2017/5

Y1 - 2017/5

N2 - Importance: Ischemic postconditioning of the heart during primary percutaneous coronary intervention (PCI) induced by repetitive interruptions of blood flow to the ischemic myocardial region immediately after reopening of the infarct-related arterymay limit myocardial damage. Objective: To determine whether ischemic postconditioning can improve the clinical outcomes in patients with ST-segment elevationmyocardial infarction (STEMI). Design, Setting, and Participants: In this multicenter, randomized clinical trial, patients with onset of symptoms within 12 hours, STEMI, and thrombolysis inmyocardial infarction (TIMI) grade 0-1 flow in the infarct-related artery at arrival were randomized to conventional PCI or postconditioning. Inclusion began on March 21, 2011, through February 2, 2014, and follow-up was completed on February 2, 2016. Analysis was based on intention to treat. Interventions: Patients were randomly allocated 1:1 to conventional primary PCI, including stent implantation, or postconditioning performed as 4 repeated 30-second balloon occlusions followed by 30 seconds of reperfusion immediately after opening of the infarct-related artery and before stent implantation. Main Outcome and Measures: A combination of all-cause death and hospitalization for heart failure. Results: During the inclusion period, 1234 patients (975 men [79.0%] and 259 women [21.0%]; mean [SD] age, 62 [11] years) underwent randomization in the trial. Median follow-up was 38 months (interquartile range, 24-58 months). The primary outcome occurred in 69 patients (11.2%) who underwent conventional primary PCI and in 65 (10.5%) who underwent postconditioning (hazard ratio, 0.93; 95%CI, 0.66-1.30; P = .66). The hazard ratios were 0.75 (95%CI, 0.49-1.14; P = .18) for all-cause death and 0.99 (95%CI, 0.60-1.64; P = .96) for heart failure. Conclusions and Relevance: Routine ischemic postconditioning during primary PCI failed to reduce the composite outcome of death from any cause and hospitalization for heart failure in patients with STEMI and TIMI grade 0-1 flow at arrival.

AB - Importance: Ischemic postconditioning of the heart during primary percutaneous coronary intervention (PCI) induced by repetitive interruptions of blood flow to the ischemic myocardial region immediately after reopening of the infarct-related arterymay limit myocardial damage. Objective: To determine whether ischemic postconditioning can improve the clinical outcomes in patients with ST-segment elevationmyocardial infarction (STEMI). Design, Setting, and Participants: In this multicenter, randomized clinical trial, patients with onset of symptoms within 12 hours, STEMI, and thrombolysis inmyocardial infarction (TIMI) grade 0-1 flow in the infarct-related artery at arrival were randomized to conventional PCI or postconditioning. Inclusion began on March 21, 2011, through February 2, 2014, and follow-up was completed on February 2, 2016. Analysis was based on intention to treat. Interventions: Patients were randomly allocated 1:1 to conventional primary PCI, including stent implantation, or postconditioning performed as 4 repeated 30-second balloon occlusions followed by 30 seconds of reperfusion immediately after opening of the infarct-related artery and before stent implantation. Main Outcome and Measures: A combination of all-cause death and hospitalization for heart failure. Results: During the inclusion period, 1234 patients (975 men [79.0%] and 259 women [21.0%]; mean [SD] age, 62 [11] years) underwent randomization in the trial. Median follow-up was 38 months (interquartile range, 24-58 months). The primary outcome occurred in 69 patients (11.2%) who underwent conventional primary PCI and in 65 (10.5%) who underwent postconditioning (hazard ratio, 0.93; 95%CI, 0.66-1.30; P = .66). The hazard ratios were 0.75 (95%CI, 0.49-1.14; P = .18) for all-cause death and 0.99 (95%CI, 0.60-1.64; P = .96) for heart failure. Conclusions and Relevance: Routine ischemic postconditioning during primary PCI failed to reduce the composite outcome of death from any cause and hospitalization for heart failure in patients with STEMI and TIMI grade 0-1 flow at arrival.

U2 - 10.1001/jamacardio.2017.0022

DO - 10.1001/jamacardio.2017.0022

M3 - Journal article

C2 - 28249094

AN - SCOPUS:85026826837

VL - 2

SP - 490

EP - 497

JO - JAMA Cardiology

JF - JAMA Cardiology

SN - 2380-6583

IS - 5

ER -