Post-conditioning reduces infarct size and edema in patients with ST-segment elevation myocardial infarction
Franck Thuny, Olivier Lairez, François Roubille, Nathan Mewton, Gilles Rioufol, Catherine Sportouch, Ingrid Sanchez, Cyrille Bergerot, Hélène Thibault, Thien Tri Cung, Gérard Finet, Laurent Argaud, Didier Revel, Geneviève Derumeaux, Eric Bonnefoy-Cudraz, Meier Elbaz, Christophe Piot, Michel Ovize, Pierre Croisille, Franck Thuny, Olivier Lairez, François Roubille, Nathan Mewton, Gilles Rioufol, Catherine Sportouch, Ingrid Sanchez, Cyrille Bergerot, Hélène Thibault, Thien Tri Cung, Gérard Finet, Laurent Argaud, Didier Revel, Geneviève Derumeaux, Eric Bonnefoy-Cudraz, Meier Elbaz, Christophe Piot, Michel Ovize, Pierre Croisille
Abstract
Objectives: This study aimed to determine whether post-conditioning at the time of percutaneous coronary intervention could reduce reperfusion-induced myocardial edema in patients with acute ST-segment elevation myocardial infarction (STEMI).
Background: Myocardial edema is a reperfusion injury with potentially severe consequences. Post-conditioning is a cardioprotective therapy that reduces infarct size after reperfusion, but no previous studies have analyzed the impact of this strategy on reperfusion-induced myocardial edema in humans.
Methods: Fifty patients with STEMI were randomly assigned to either a control or post-conditioned group. Cardiac magnetic resonance imaging was performed within 48 to 72 h after admission. Myocardial edema was measured by T2-weighted sequences, and infarct size was determined by late gadolinium enhancement sequences and creatine kinase release.
Results: The post-conditioned and control groups were similar with respect to ischemia time, the size of the area at risk, and the ejection fraction before percutaneous coronary intervention. As expected, post-conditioning was associated with smaller infarct size (13 ± 7 g/m(2) vs. 21 ± 14 g/m(2); p = 0.01) and creatine kinase peak serum level (median [interquartile range]: 1,695 [1,118 to 3,692] IU/l vs. 3,505 [2,307 to 4,929] IU/l; p = 0.003). At reperfusion, the extent of myocardial edema was significantly reduced in the post-conditioned group as compared with the control group (23 ± 16 g/m(2) vs. 34 ± 18 g/m(2); p = 0.03); the relative increase in T2W signal intensity was also significantly lower (p = 0.02). This protective effect was confirmed after adjustment for the size of the area at risk.
Conclusions: This randomized study demonstrated that post-conditioning reduced infarct size and edema in patients with reperfused STEMI.
Trial registration: ClinicalTrials.gov NCT01208727.
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed