Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy.
Int J Cardiol. 2012 Dec 15;162(1):33-8. doi: 10.1016/j.ijcard.2012.03.136. Epub 2012 Apr 9.
Postconditioning (PC) has been suggested to reduce myocardial damage during primary percutaneous coronary intervention (PPCI), nevertheless clinical experience is limited. We aimed to explore the cardioprotective effect of PC using cardiac magnetic resonance (CMR) in ST-elevation myocardial infarction (STEMI) patients treated by PPCI.
A total of 78 patients with first STEMI (aged 59±12 years) referred for PPCI, were stratified for STEMI location and randomly assigned to conventional PPCI or PPCI with PC. All patients, with occluded infarct related artery and no collateral circulation, received abciximab intravenously before PPCI. After reperfusion by effective direct stenting, control subjects underwent no further intervention, while in treated patients PC was performed within 1 min of reflow by 4 cycles of 1-minute inflation and 1-minute deflation of the angioplasty balloon. Primary end-point was infarct size (IS) reduction, expressed as percentage of left ventricle mass assessed by delayed enhancement on CMR at 30±10 days after index PPCI.
All baseline characteristics but diabetes (p=0.06) were balanced between groups. Postconditioning patients trended toward a larger IS compared to those treated by standard PPCI (20±12% vs 14±10%, p=0.054). After exclusion of diabetics, PC group still showed a trend to larger IS (p=0.116). Major adverse events seem to be more frequent in PC group irrespective to diabetic status (p=0.053 and p=0.080, respectively).
This prospective, randomized trial suggests that PC did not have the expected cardioprotective effect and on the contrary it might harm STEMI patients treated by PPCI plus abciximab. (Clinical Trial Registration-unique identifier: NCT01004289).
后处理（PC）已被建议用于减少经皮冠状动脉介入治疗（PPCI）期间的心肌损伤，但临床经验有限。我们旨在通过 ST 段抬高型心肌梗死（STEMI）患者接受 PPCI 治疗的心脏磁共振（CMR）来探索 PC 的心脏保护作用。
共纳入 78 例首次发生 STEMI 的患者（年龄 59±12 岁），根据 STEMI 部位进行分层，并随机分为常规 PPCI 组或 PPCI 加 PC 组。所有患者均在 PPCI 前静脉注射阿昔单抗。在有效的直接支架置入再灌注后，对照组不再进行进一步干预，而在治疗组中，在再灌注后 1 分钟内通过 4 个 1 分钟充气和 1 分钟放气的球囊进行 PC。主要终点是通过 CMR 在 PPCI 后 30±10 天评估的左心室质量的梗死面积（IS）减少百分比。
除糖尿病外（p=0.06），两组间所有基线特征均平衡。与标准 PPCI 治疗组相比，PC 组的 IS 更大（20±12%对 14±10%，p=0.054）。排除糖尿病患者后，PC 组的 IS 仍有增大趋势（p=0.116）。无论糖尿病状态如何，PC 组的主要不良事件似乎更为频繁（p=0.053 和 p=0.080，分别）。
这项前瞻性、随机试验表明，PC 没有预期的心脏保护作用，反而可能损害接受 PPCI 加阿昔单抗治疗的 STEMI 患者。（临床试验注册编号：NCT01004289）。
