Effect of postconditioning in patients with ST-elevation acute myocardial infarction
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ORIGINAL ARTICLE
Effect of postconditioning in patients with ST-elevation acute myocardial infarction Yusuke Ugata • Tomohiro Nakamura • Yousuke Taniguchi • Junya Ako • Shinichi Momomura
Received: 7 April 2011 / Accepted: 28 June 2011 / Published online: 9 August 2011 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2011
Abstract Postconditioning (PosC), which is a brief period of ischemia performed at the time of reperfusion therapy, reduces the infarct size in animal models. We aim to evaluate the impact of PosC in patients with ST-elevation acute myocardial infarction (STEMI). Between January 2008 and August 2009, 37 STEMI patients received PosC. The control group comprised 42 age- and sex-matched patients diagnosed with STEMI in 2007–2008. In the PosC group, we applied four cycles of 30-s balloon inflation and 30-s balloon deflation within 3 min after thrombectomy, and implanted the stent after PosC. In the control group, we directly implanted the stent after thrombectomy. The number of patients with myocardial blush grade 2 or 3 after the procedure was higher in the PosC group than in the control group (65 vs. 43%, p = 0.04). The ST-segment resolution [50% was greater in the PosC group compared to the control group (81 vs. 57%, p = 0.02). Serial changes of creatine kinase and creatine kinase myocardial fraction after reperfusion were significantly lower in the PosC group than in the control group. In conclusion, PosC is a safe and feasible strategy that might preserve myocardial perfusion and reduce the infarct size in patients with STEMI.
Introduction Percutaneous coronary intervention (PCI) is effective for ST-elevation acute myocardial infarction (STEMI). Early reperfusion of the infarct related coronary artery has become the therapy of choice for STEMI patients. However, reperfusion therapy has the potential to cause additional reversible and irreversible damage to the myocardium, which is called reperfusion injury [1]. A phenomenon of ischemic preconditioning, which is brief periods of ischemia–reperfusion preceding prolonged coronary artery occlusion, provides tolerance to ischemia resulting in the reduction of infarct size [2]. Since ischemic pre-conditioning is performed before the onset of coronary artery occlusion, it has limited availability as an acute treatment in patients with STEMI. A related phenomenon called ischemic postconditioning (PosC), which involves performing repeated brief cycles of ischemia at the time of reperfusion therapy, is reported to be clinically feasible [3]. In animal models, PosC is almost as effective as ischemic pre-conditioning in reducing the infarct size and involves similar pathogenetic mechanisms to pre-conditioning [4, 5]. In the present study, we investigated the effect of PosC after reperfusion in patients with STEMI.
Keywords ST-elevation AMI Post-conditioning Myocardial perfusion Methods Y. Ugata T. Nakamura (&) Y. Taniguchi Cardiovascular Division, Saitama Citizens Medical Center, 299-1 Shimane, Nishi-ku, Saitama, Saitama 331-0
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