Key result
Ischemic postconditioning during primary PCI significantly reduced total CPK-MB release compared to conventional PCI (9632 IU vs 13493 IU; P=0.0347), representing a 29% reduction in infarct size.
Why the study?
Reperfusion therapy can cause deleterious effects such as myocardial necrosis and no-reflow, and human studies evaluating ischemic postconditioning for cardioprotection have shown inconsistent results.
Does ischemic postconditioning during primary PCI reduce infarct size in patients with STEMI?
RCT (n=43)
randomized
No
Does ischemic postconditioning during primary PCI reduce infarct size in patients with STEMI?
Effect estimate: 29% reduction
Absolute Event Rate: 9632% vs 13493%
p-value: p=0.0347
Ischemic postconditioning during primary PCI for STEMI significantly reduces enzymatic infarct size and improves myocardial blush grade compared to conventional PCI.
Supports ischemic postconditioning in STEMI primary PCI; extends randomized evidence for infarct limitation.
Background and Objective: Reperfusion therapy for acute myocardial infarction has been shown to reduce mortality, yet it may also have deleterious effects, including myocardial necrosis and no-reflow. Postconditioning is known measure for cardioprotection from reperfusion injury in animal model. Postconditioning is known measure for cardioprotection from reperfusion injury in animal model and human studies have shown inconsistent results. Materials and Methods: From February 2013 through October 2014, at Institute of Postgraduate Medical Education and Research, Kolkata Cardiology department, we randomized 43 patients with acute ST-segment elevation myocardial infarction (STEMI) who were undergoing conventional primary percutaneous coronary intervention (PCI) (22 patients) and PCI with postconditioning by repeated transient balloon occlusion after establishment of flow (21 patients). Total creatine kinase-muscle/brain (CPK-MB) released within 72 h was compared as a surrogate marker of infarct size. Myocardial blush grade between two groups was also compared. Results: 72 h of reperfusion was significantly reduced (P = 0.0347) in the postconditioned group compared with the control group, averaging 9632 IU in postconditioned compared with 13493 IU in control group which represented 29% of reduction of infarct size. The peak of CPK-MB release was markedly lower in the postconditioned (290 ± 16.24 IU/L) than in the control (414.2 ± 51.34 IU/L) group (P ≤ 0.0001). Blush grading was also significantly improved in postconditioned group (P = 0.005). Mean ST-segment deviation at 48 h between cases and control groups was 0.87 ± 0.68 and 1.4 ± 0.94, respectively (P = 0.08). Conclusion: In patients with STEMI, postconditioning significantly improves blush grading and enzymatic infarct size reduction with a trend toward significant reduction of mean ST-segment deviation.
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Mukherjee et al. (2019) conducted an RCT in acute ST-segment elevation myocardial infarction (STEMI) (n=43). PCI with postconditioning by repeated transient balloon occlusion vs. conventional primary percutaneous coronary intervention (PCI) was evaluated on Total creatine kinase-muscle/brain (CPK-MB) released within 72 h (29% reduction, p=0.0347). Ischemic postconditioning during primary PCI significantly reduced total CPK-MB release compared to conventional PCI (9632 IU vs 13493 IU; P=0.0347), representing a 29% reduction in infarct size.
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