Effect of ischemic postconditioning on microvascular obstruction in reperfused myocardial infarction. Results of a randomized study in patients and of an experimental model in swine

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• 作者：Vicente Bodi^a ; ^{vicentbodi@hotmail.com" class="auth_mail} ; Juan M. Ruiz-Nodar^b ; Eloisa Feliu^c ; Gema Minana^a ; Julio Nunez^a ; Oliver Husser^d ; Javier Martinez-Elvira^b ; Amparo Ruiz^e ; Clara Bonanad^a ; Jose V. Monmeneu^f ; Maria P. Lopez-Lereu^f ; Maria J. Forteza^a ; Elena de Dios^a ; Arantxa Hervas^a ; David Moratal^g ; Cristina Gomez^a ; Luis Mainar^a ; Juan Sanchis^a ; Vicente Mainar^b ; Jose Valencia^b ; Ana Diaz^e ; Inmaculada Noguera^e ; Fabian Chaustre^a ; Francisco J. Chorro^a
• 关键词：Myocardial infarction ; Perfusion ; Ischemic postconditioning
• 刊名：International Journal of Cardiology
• 出版年：15 July 2014
• 年：2014
• 卷：175
• 期：1
• 页码：138-146
• 全文大小：1396 K

文摘

Ischemic postconditioning (PCON) appears as a potentially beneficial tool in ST-segment elevation myocardial infarction (STEMI). We evaluated the effect of PCON on microvascular obstruction (MVO) in STEMI patients and in an experimental swine model.

Methods

A prospective randomized study in patients and an experimental study in swine were carried out in two university hospitals in Spain. 101 consecutive STEMI patients were randomized to undergo primary angioplasty followed by PCON or primary angioplasty alone (non-PCON). Using late gadolinium enhancement cardiovascular magnetic resonance, infarct size and MVO were quantified (% of left ventricular mass). In swine, using an angioplasty balloon-induced anterior STEMI model, MVO was defined as the % of area at risk without thioflavin-S staining.

Results

In patients, PCON (n = 49) in comparison with non-PCON (n = 52) did not significantly reduce MVO (0 [0–1.02]% vs. 0 [0–2.1]% p = 0.2) or IS (18 ± 13% vs. 21 ± 14%, p = 0.2). MVO (> 1 segment in the 17-segment model) occurred in 12/49 (25%) PCON and in 18/52 (35%) non-PCON patients, p = 0.3. No significant differences were observed between PCON and non-PCON patients in left ventricular volumes, ejection fraction or the extent of hemorrhage. In the swine model, MVO occurred in 4/6 (67%) PCON and in 4/6 (67%) non-PCON pigs, p = 0.9. The extent of MVO (10 ± 7% vs. 10 ± 8%, p = 0.9) and infarct size (23 ± 14% vs. 24 ± 10%, p = 0.8) was not reduced in PCON compared with non-PCON pigs.

Conclusions

Ischemic postconditioning does not significantly reduce microvascular obstruction in ST-segment elevation myocardial infarction.

Clinical Trial Registration

http://www.clinicaltrials.gov. Unique identifier: NCT01898546.