Key result
POST-AMI trial evaluates whether ischemic postconditioning reduces 30-day infarct size in STEMI.
Why the study?
Reperfusion after acute myocardial infarction can exacerbate ischemia-related injury, and postconditioning might modify reperfusion-induced adverse events.
Does postconditioning during primary angioplasty reduce infarct size in patients with ST-elevation acute myocardial infarction?
RCT (n=78)
Randomly assigned
No
Does postconditioning during primary angioplasty reduce infarct size in patients with ST-elevation acute myocardial infarction?
This paper describes the design of the POST-AMI trial, which will evaluate whether postconditioning during primary angioplasty reduces infarct size in patients with ST-elevation myocardial infarction.
Postconditioning should not yet alter STEMI PCI practice; leaves open whether it benefits subgroups or modern protocols without abciximab.
BACKGROUND: Reperfusion remains the definitive treatment for acute myocardial infarction (AMI), but restoring blood flow carries the potential to exacerbate the ischemia-related injury. Postconditioning might modify reperfusion-induced adverse events. STUDY DESIGN: The POSTconditioning during Coronary Angioplasty in Acute Myocardial Infarction (POST-AMI) trial is a single-center, prospective, randomized study, with a planned inclusion of 78 patients with ST-elevation AMI. Patients will be randomly assigned to the postconditioning arm [primary angioplasty (PA) and stenting followed by brief episodes of ischemia-reperfusion early after recanalization] or non-postconditioning arm. All patients will be treated medically according to current international guidelines, including glycoprotein IIb/IIIa inhibitors before PA. The primary end point is to evaluate whether postconditioning, compared to plain PA, reduces infarct size estimated by cardiac magnetic resonance (CMR) at 30 +/- 10 days after the AMI. Secondary end points are microvascular obstruction observed at CMR, ST-segment resolution, angiographic myocardial blush grade <2, non-sustained/sustained ventricular tachycardia in the 48 h following PA, left ventricular remodeling and function at follow-up CMR, and the reduction of major adverse cardiac events at 30 days and 6 months. CONCLUSION: The POST-AMI trial will evaluate the usefulness of postconditioning in limiting infarct size during the early and late phases after AMI.
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Tarantini et al. (2010) conducted an RCT in ST-elevation acute myocardial infarction (n=78). Postconditioning (brief episodes of ischemia-reperfusion) vs. Plain primary angioplasty was evaluated on Infarct size estimated by cardiac magnetic resonance at 30 +/- 10 days. The POST-AMI trial is designed to evaluate whether postconditioning during primary angioplasty reduces infarct size at 30 days in patients with ST-elevation acute myocardial infarction.
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