No Cardioprotective Benefit of Ischemic Postconditioning in Patients With ST-Segment Elevation Myocardial Infarction

BackgroundPostconditioning is a potential cardioprotective strategy that has demonstrated conflicting and variable reductions in infarct size in human trials. ObjectivesTo determine whether postconditioning could increase the extent of myocardial salvage in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (PPCI). MethodsOne hundred two patients (aged 5711 years; 88% male) were randomly assigned to a postconditioning or standard protocol. Cardiovascular magnetic resonance imaging was performed 3 days after PPCI to measure the volumetric extent of myocardial necrosis and the area at risk. ResultsWith similar time-to-reperfusion (170 +/- 84minutes in the postconditioning group vs. 150 +/- 70minutes in the standard group, P=0.22), the myocardial salvage index was not significantly different between the postconditioned group and the control group, averaging 42 +/- 22% vs. 33 +/- 21%, respectively (P=0.08). Furthermore, postconditioning was not associated with a smaller infarct size compared to controls (13 +/- 7g/m(2)vs. 15 +/- 8g/m(2), respectively, P=0.18). ConclusionsPostconditioning does not significantly increase myocardial salvage or reduce infarct size in patients with STEMI undergoing PPCI. However, the possibility of a more modest impact of postconditioning cannot be excluded with our sample size. (J Interven Cardiol 2013;26:482-490)