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Am Heart J. 2015 May;169(5):639-46. doi: 10.1016/j.ahj.2015.01.015. Epub 2015 Feb 27.

Long-term effects of ischemic postconditioning on clinical outcomes: 1-year follow-up of the POST randomized trial.

Author information

1
Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address: jyhahn@skku.edu.
2
Korea University Anam Hospital, Seoul, Korea.
3
Kyungpook National University Hospital, Daegu, Korea. Electronic address: hspark@knu.ac.kr.
4
Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
5
Sejong General Hospital, Bucheon, Korea.
6
Chungbuk National University College of Medicine, Cheongju, Korea.
7
Seoul National University Boramae Medical Center, Seoul, Korea.
8
Konyang University Hospital, Daejon, Korea.
9
KEPCO Medical Center, Seoul, Korea.
10
Yeungnam University Hospital, Daegu, Korea.
11
Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
12
Chung-Ang University Hospital, Seoul, Korea.
13
Gyeongsang National University Hospital, Jinju, Korea.
14
Daegu Catholic University Medical Center, Daegu, Korea.

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

Ischemic postconditioning does not seem to improve the 1-year clinical outcomes in patients with ST-segment elevation myocardial infarction undergoing primary PCI.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00942500.

PMID:
25965711
DOI:
10.1016/j.ahj.2015.01.015
[Indexed for MEDLINE]

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