Long-term effects of ischemic postconditioning on clinical outcomes: 1-year follow-up of the POST randomized trial - 09/05/15
, Cheol Woong Yu, MD b, n, Hun Sik Park, MD c , Young Bin Song, MD a, Eun Kyoung Kim, MD a, Hyun Jong Lee, MD d, Jang-Whan Bae, MD e, Woo-Young Chung, MD f, Seung-Hyuk Choi, MD a, Jin-Ho Choi, MD a, Jang-Ho Bae, MD g, Kyung Joo An, MD h, Jong-Seon Park, MD i, Ju Hyeon Oh, MD j, Sang-Wook Kim, MD k, Jin-Yong Hwang, MD l, Jae Kean Ryu, MD m, Do-Sun Lim, MD b, Hyeon-Cheol Gwon, MD aRésumé |
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.
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| RCT# NCT00942500. |
Vol 169 - N° 5
P. 639-646 - mai 2015 Retour au numéro
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