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 Juhl
AU - Maeng, Michael
AU - Kaltoft, Anne
AU - Krusell, Lars Romer
AU - Jensen, Lisette O
AU - Veien, Karsten Tange
AU - Kofoed, Klaus Fuglsang
AU - Torp-Pedersen, Christian
AU - Kyhl, Kasper
AU - Nepper-Christensen, Lars
AU - Treiman, Marek
AU - Vejlstrup, Niels
AU - Ahtarovski, Kiril A
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
N1 - This article has been found as a 'Free Version' from the Publisher on July 26th 2018. When the access to the article closes, please notify vbn@aub.aau.dk
PY - 2017
Y1 - 2017
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 artery may limit myocardial damage.Objective: To determine whether ischemic postconditioning can improve the clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI).Design, Setting, And Participants: In this multicenter, randomized clinical trial, patients with onset of symptoms within 12 hours, STEMI, and thrombolysis in myocardial 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.Trial Registration: clinicaltrials.gov Identifier: NCT01435408.
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 artery may limit myocardial damage.Objective: To determine whether ischemic postconditioning can improve the clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI).Design, Setting, And Participants: In this multicenter, randomized clinical trial, patients with onset of symptoms within 12 hours, STEMI, and thrombolysis in myocardial 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.Trial Registration: clinicaltrials.gov Identifier: NCT01435408.
KW - Journal Article
UR - https://jamanetwork.com/journals/jamacardiology/fullarticle/2606433
U2 - 10.1001/jamacardio.2017.0022
DO - 10.1001/jamacardio.2017.0022
M3 - Journal article
C2 - 28249094
SN - 2380-6583
VL - 2
SP - 490
EP - 497
JO - JAMA Cardiology
JF - JAMA Cardiology
IS - 5
ER -