title: Long-term benefit of postconditioning.
abstract: BACKGROUND
  We previously demonstrated that ischemic postconditioning decreases creatine kinase release, a surrogate marker for infarct size, in patients with acute myocardial infarction. Our objective was to determine whether ischemic postconditioning could afford (1) a persistent infarct size limitation and (2) an improved recovery of myocardial contractile function several months after infarction.
  
  
  RESULTS
  Patients presenting within 6 hours of the onset of chest pain, with suspicion for a first ST-segment-elevation myocardial infarction, and for whom the clinical decision was made to treat with percutaneous coronary intervention, were eligible for enrollment. After reperfusion by direct stenting, 38 patients were randomly assigned to a control (no intervention; n=21) or postconditioned group (repeated inflation and deflation of the angioplasty balloon; n=17). Infarct size was assessed both by cardiac enzyme release during early reperfusion and by 201thallium single photon emission computed tomography at 6 months after acute myocardial infarction. At 1 year, global and regional contractile function was evaluated by echocardiography. At 6 months after acute myocardial infarction, single photon emission computed tomography rest-redistribution index (a surrogate for infarct size) averaged 11.8+/-10.3% versus 19.5+/-13.3% in the postconditioned versus control group (P=0.04), in agreement with the significant reduction in creatine kinase and troponin I release observed in the postconditioned versus control group (-40% and -47%, respectively). At 1 year, the postconditioned group exhibited a 7% increase in left ventricular ejection fraction compared with control (P=0.04).
  
  
  CONCLUSIONS
  Postconditioning affords persistent infarct size reduction and improves long-term functional recovery in patients with acute myocardial infarction.
authors.affiliation: Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Thibault
authors.forename: Christophe
authors.initials: C
authors.lastname: Piot
authors.forename: Patrick
authors.initials: P
authors.lastname: Staat
authors.forename: Laurence
authors.initials: L
authors.lastname: Bontemps
authors.forename: Catherine
authors.initials: C
authors.lastname: Sportouch
authors.forename: Gilles
authors.initials: G
authors.lastname: Rioufol
authors.forename: Thien Tri
authors.initials: TT
authors.lastname: Cung
authors.forename: Eric
authors.initials: E
authors.lastname: Bonnefoy
authors.forename: Denis
authors.initials: D
authors.lastname: Angoulvant
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Aupetit
authors.forename: Gérard
authors.initials: G
authors.lastname: Finet
authors.forename: Xavier
authors.initials: X
authors.lastname: André-Fouët
authors.forename: Jean Christophe
authors.initials: JC
authors.lastname: Macia
authors.forename: Franck
authors.initials: F
authors.lastname: Raczka
authors.forename: Rolland
authors.initials: R
authors.lastname: Rossi
authors.forename: Rolland
authors.initials: R
authors.lastname: Itti
authors.forename: Gilbert
authors.initials: G
authors.lastname: Kirkorian
authors.forename: Geneviève
authors.initials: G
authors.lastname: Derumeaux
authors.forename: Michel
authors.initials: M
authors.lastname: Ovize
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D003402:Creatine Kinase / Q000097:blood; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000628:therapy*; D015428:Myocardial Reperfusion Injury / Q000000981:diagnostic imaging* / Q000628:therapy*; D020127:Recovery of Function; D015607:Stents; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
chemical_list: D019210:Troponin I; D003402:Creatine Kinase