Long-term effects of ischemic postconditioning on clinical outcomes: 1-year follow-up of the POST randomized trial.

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.

• Authors: Joo-Yong Hahn, Cheol Woong Yu, Hun Sik Park, Young Bin Song, Eun Kyoung Kim, Hyun Jong Lee, Jang-Whan Bae, Woo-Young Chung, Seung-Hyuk Choi, Jin-Ho Choi, Jang-Ho Bae, Kyung Joo An, Jong-Seon Park, Ju Hyeon Oh, Sang-Wook Kim, Jin-Yong Hwang, Jae Kean Ryu, Do-Sun Lim, Hyeon-Cheol Gwon
• Journal: American heart journal (Am Heart J) Vol. 169 Issue 5 Pg. 639-46 (May 2015) ISSN: 1097-6744 [Electronic] United States
• PMID: 25965711 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Topics

• Aged
• Coronary Thrombosis (epidemiology, etiology)
• Female
• Follow-Up Studies
• Heart Failure (epidemiology, etiology)
• Humans
• Ischemic Postconditioning
• Male
• Middle Aged
• Myocardial Infarction (complications, mortality, therapy)
• Percutaneous Coronary Intervention
• Risk
• Stents
• Treatment Outcome