Ischemic Postconditioning During Primary Percutaneous Coronary Intervention The Effects of Postconditioning on Myocardial Reperfusion in Patients With ST-Segment Elevation Myocardial Infarction (POST) Randomized Trial

被引：156

作者：

Hahn, Joo-Yong ^{[1
]}

Song, Young Bin ^{[1
]}

Kim, Eun Kyoung ^{[1
]}

Yu, Cheol Woong ^{[2
]}

Bae, Jang-Whan ^{[3
]}

Chung, Woo-Young ^{[4
]}

Choi, Seung-Hyuk ^{[1
]}

Choi, Jin-Ho ^{[1
]}

Bae, Jang-Ho ^{[5
]}

An, Kyung Joo ^{[6
]}

Park, Jong-Seon ^{[7
]}

Oh, Ju Hyeon ^{[8
]}

Kim, Sang-Wook ^{[9
]}

Hwang, Jin-Yong ^{[10
]}

Ryu, Jae Kean ^{[11
]}

Park, Hun Sik ^{[12
]}

Lim, Do-Sun ^{[13
]}

Gwon, Hyeon-Cheol ^{[1
]}

机构：

[1] Sungkyunkwan Univ, Sch Med, Samsung Med Ctr, Div Cardiol,Dept Med, Seoul 135710, South Korea

[2] Sejong Gen Hosp, Puchon, South Korea

[3] Chungbuk Natl Univ Hosp, Cheongju, South Korea

[4] Seoul Natl Univ, Boramae Med Ctr, Seoul, South Korea

[5] Konyang Univ Hosp, Taejon, South Korea

[6] KEPCO Med Ctr, Seoul, South Korea

[7] Yeungnam Univ Hosp, Taegu, South Korea

[8] Sungkyunkwan Univ, Sch Med, Samsung Changwon Hosp, Chang Won, South Korea

[9] Chung Ang Univ Hosp, Seoul, South Korea

[10] Gyeongsang Natl Univ Hosp, Jinju, South Korea

[11] Daegu Catholic Univ, Med Ctr, Taegu, South Korea

[12] Kyungpook Natl Univ Hosp, Taegu, South Korea

[13] Korea Univ, Anam Hosp, Seoul, South Korea

来源：

CIRCULATION | 2013年 / 128卷 / 17期

关键词：

ischemic postconditioning; myocardial infarction; percutaneous coronary intervention; MITOCHONDRIAL PERMEABILITY TRANSITION; PROGNOSTIC-SIGNIFICANCE; PRIMARY ANGIOPLASTY; HUMAN HEART; INJURY; SIZE; RESOLUTION; FLOW;

D O I：

10.1161/CIRCULATIONAHA.113.001690

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Ischemic postconditioning has been reported to reduce infarct size in patients with ST-segment-elevation myocardial infarction. However, cardioprotective effects of postconditioning have not been demonstrated in a large-scale trial. Methods and Results We performed a multicenter, prospective, randomized, open-label, blinded end-point trial. A total of 700 patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment-elevation myocardial infarction within 12 hours after symptom onset were randomly assigned to the postconditioning group or to the conventional primary PCI group in a 1:1 ratio. Postconditioning was performed immediately after restoration of coronary flow as follows: The angioplasty balloon was positioned at the culprit lesion and inflated 4 times for 1 minute with low-pressure (<6 atm) inflations, each separated by 1 minute of deflation. The primary end point was complete ST-segment resolution (percentage resolution of ST-segment elevation >70%) measured at 30 minutes after PCI. Complete ST-segment resolution occurred in 40.5% of patients in the postconditioning group and 41.5% of patients in the conventional PCI group (absolute difference, -1.0%; 95% confidence interval, -8.4 to 6.4; P=0.79). The rate of myocardial blush grade of 0 or 1 and the rate of major adverse cardiac events (a composite of death, myocardial infarction, severe heart failure, or stent thrombosis) at 30 days did not differ significantly between the postconditioning group and the conventional PCI group (17.2% versus 22.4% [P=0.20] and 4.3% versus 3.7% [P=0.70], respectively). Conclusion Ischemic postconditioning did not improve myocardial reperfusion in patients with ST-segment-elevation myocardial infarction undergoing primary PCI with current standard practice. Clinical Trial Registration URL: http://clinicaltrials.gov. Unique identifier: NCT00942500.

引用

页码：1889 / 1896

页数：8

共 29 条

[1] Postconditioning inhibits mitochondrial permeability transition [J].