Postconditioning the human heart in percutaneous coronary intervention.
BACKGROUND
It has been proved in animal models that postconditioning (PC) could attenuate reperfusion injury. But there are not many clinical studies on the application of PC.


OBJECTIVE
Four cycles of 1-minute balloon inflation and deflation, following initial balloon reperfusion in ST-segment elevation myocardial infarction (MI) but before stenting, might improve clinical outcomes compared with primary percutaneous coronary intervention (PCI) alone.


METHODS
Forty-three patients diagnosed with acute MI were randomly assigned to 2 groups: the control group (n = 20) and the PC group (n = 23). Blood samples were obtained and assayed for creatine kinase MB (CK-MB) and high-sensitive C-reactive protein. Electrocardiogram, echocardiography, and rest technetium Tc 99m-sestamibi (99mTc-MIBI) myocardial perfusion single-photon emission computed tomography (SPECT) were performed.


RESULTS
The control group presented with higher peak CK-MB as compared with the PC group (351.9 +/- 153.6 vs 247.7 +/- 118.3 U/L, P = 0.028) as well as the area under the curve (AUC) of CK-MB (8040 +/- 3358 vs 5955 +/- 2509, P = 0.04). After PCI, PC was associated with a lower level of hs-CRP in comparison with the control group (5.5 +/- 4.5 vs 9.5 +/- 5.2 mg/L, P = 0.019). More patients in the PC group had complete ST-segment resolution than did patients in the control group (82.6% vs 45.0%, P = 0.049). Left ventricle ejection fraction was better in the PC group than in the control group (0.57 +/- 0.09 vs 0.47 +/- 0.11, P = 0.002). Compared with the control group, PC greatly reduced infarct size, by 46% as measured by SPECT (13 +/- 11.2% vs 24.2 +/- 10.6%, P = 0.002).


CONCLUSIONS
This study indicated that PC in emergent PCI was a valuable modification of primary PCI.
Xue
Feng
F
Department of Cardiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Yang
Xiangjun
X
Zhang
Bing
B
Zhao
Caiming
C
Song
Jianping
J
Jiang
Tingbo
T
Jiang
Wenping
W
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002681:China; D052279:Creatine Kinase, MB Form / Q000097:blood; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D055414:Myocardial Perfusion Imaging / Q000379:methods; D015428:Myocardial Reperfusion Injury / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D009206:Myocardium / Q000201:enzymology / Q000473:pathology; D015607:Stents; D013318:Stroke Volume; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D016277:Ventricular Function, Left
D015415:Biomarkers; D002097:C-Reactive Protein; D052279:Creatine Kinase, MB Form