Comparison of Effect of Ischemic Postconditioning on Cardiovascular Mortality in Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention With Versus Without Thrombectomy.

Abstract

In patients with ST-segment elevation myocardial infarction (STEMI), ischemic postconditioning (iPOST) have shown ambiguous results in minimizing reperfusion injury. Previous findings show beneficial effects of iPOST in patients with STEMI treated without thrombectomy. However, it remains unknown whether the cardioprotective effect of iPOST in these patients persist on long term. In the current study, all patients were identified through the DANAMI-3-iPOST database. Patients were randomized to conventional primary percutaneous coronary intervention (PCI) or iPOST in addition to PCI. Cumulative incidence rates were calculated, and multivariable analyses stratified according to thrombectomy use were performed. The primary end point was a combination of cardiovascular mortality and hospitalization for heart failure. From 2011 to 2014, 1,234 patients with STEMI were included with a median follow-up of 4.8 years. In patients treated without thrombectomy (n = 520), the primary end point occurred in 15% (48/326) in the iPOST group and in 22% (42/194) in the conventional group (unadjusted hazard ratio [HR] 0.62, 95% confidence interval [CI] 0.41 to 0.94, p = 0.023). In adjusted Cox analysis, iPOST remained associated with reduced long-term risk of cardiovascular mortality (HR 0.53, 95% CI 0.29 to 0.97, p = 0.039). In patients treated with thrombectomy (n = 714), there was no significant difference between iPOST (17%, 49/291) and conventional treatment (17%, 72/423) on the primary end point (unadjusted HR 1.01, 95% CI 0.70 to 1.45, p = 0.95). During a follow-up of nearly 5 years, iPOST reduced long-term occurrence of cardiovascular mortality and hospitalization for heart failure in patients with STEMI treated with PCI but without thrombectomy.

• Authors: Jasmine Melissa Madsen, Charlotte Glinge, Reza Jabbari, Lars Nepper-Christensen, Dan Eik Høfsten, Hans-Henrik Tilsted, Lene Holmvang, Frants Pedersen, Francis Richard Joshi, Rikke Sørensen, Lia Evi Bang, Hans Erik Bøtker, Christian Juhl Terkelsen, Michael Mæng, Lisette Okkels Jensen, Jens Aarøe, Henning Kelbæk, Christian Torp-Pedersen, Lars Køber, Jacob Thomsen Lønborg, Thomas Engstrøm
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 166 Pg. 18-24 (03 01 2022) ISSN: 1879-1913 [Electronic] United States
• PMID: 34930614 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.

Topics

• Heart Failure (epidemiology)
• Humans
• Ischemic Postconditioning (adverse effects, methods)
• Percutaneous Coronary Intervention (methods)
• ST Elevation Myocardial Infarction (complications, surgery)
• Thrombectomy (methods)
• Treatment Outcome