Hahn Joo-Yong, Yu Cheol Woong, Park Hun Sik, Song Young Bin, Kim Eun Kyoung, Lee Hyun Jong, Bae Jang-Whan, Chung Woo-Young, Choi Seung-Hyuk, Choi Jin-Ho, Bae Jang-Ho, An Kyung Joo, Park Jong-Seon, Oh Ju Hyeon, Kim Sang-Wook, Hwang Jin-Yong, Ryu Jae Kean, Lim Do-Sun, Gwon Hyeon-Cheol
Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Korea University Anam Hospital, Seoul, Korea.
Am Heart J. 2015 May;169(5):639-46. doi: 10.1016/j.ahj.2015.01.015. Epub 2015 Feb 27.
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.
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.
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.
Ischemic postconditioning does not seem to improve the 1-year clinical outcomes in patients with ST-segment elevation myocardial infarction undergoing primary PCI.
在ST段抬高型心肌梗死患者心肌再灌注的缺血后适应作用（POST）试验中，缺血后适应未能改善心肌再灌注。然而，缺血后适应对ST段抬高型心肌梗死患者临床结局的长期影响尚不清楚。
总共700例行直接经皮冠状动脉介入治疗（PCI）的患者按1:1比例随机分配至后适应组或传统直接PCI组。在冠状动脉血流恢复后立即通过球囊闭塞进行4次每次1分钟的后适应。695例患者（99.3%）获得了1年时主要临床事件的完整随访数据，并根据意向性治疗原则进行分析。主要结局为1年时死亡、心肌梗死、严重心力衰竭或支架血栓形成的复合事件。
1年时，后适应组21例患者（6.1%）发生死亡、心肌梗死、严重心力衰竭或支架血栓形成的复合事件，传统PCI组16例患者（4.6%）发生该复合事件（风险比[HR]1.32，95%置信区间0.69 - 2.53，P = 0.40）。两组间死亡风险（4.9%对3.7%，HR 1.32，95%置信区间0.64 - 2.71，P = 0.46）、心力衰竭风险（2.6%对2.3%，HR 1.13，95%置信区间0.44 - 2.94，P = 0.80）和支架血栓形成风险（2.3%对1.7%，HR 1.34，95%置信区间0.46 - 3.85，P = 0.59）无显著差异。
缺血后适应似乎并未改善接受直接PCI的ST段抬高型心肌梗死患者的1年临床结局。
