title: Ischaemic postconditioning revisited: lack of effects on infarct size following primary percutaneous coronary intervention.
abstract: OBJECTIVE
  To assess the short- and long-term effects of postconditioning (p-cond) on infarct size, extent of myocardial salvage, and left ventricular ejection fraction (LVEF) in a series of patients presenting with evolving ST-elevation myocardial infarction (STEMI). Previous studies have shown that p-cond during primary percutaneous coronary intervention (PCI) confers protection against ischaemia-reperfusion injury and thus might reduce myocardial infarct size.
  
  
  RESULTS
  Seventy-nine patients undergoing PCI for a first STEMI with TIMI grade flow 0-1 and no collaterals were randomized to p-cond (n= 39) or controls (n= 40). Postconditioning was performed by applying four consecutive cycles of 1 min balloon inflation, each followed by 1 min deflation. Infarct size, myocardial salvage, and LVEF were assessed by cardiac-MRI 1 week and 6 months after MI. Postconditioning was associated with lower myocardial salvage (4.1 ± 7.2 vs. 9.1 ± 5.8% in controls; P= 0.004) and lower myocardial salvage index (18.9 ± 27.4 vs. 30.9 ± 20.5% in controls; P= 0.038). No significant differences in infarct size and LVEF were found between the groups at 1 week and 6 months after MI.
  
  
  CONCLUSIONS
  This randomized study suggests that p-cond during primary PCI does not reduce infarct size or improve myocardial function recovery at both short- and long-term follow-up and might have a potential harmful effect.
authors.affiliation: Interventional Cardiology Section, Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Villarroel 170, Barcelona 08036, Catalonia, Spain. freixa@clinic.ub.es
authors.forename: Xavier
authors.initials: X
authors.lastname: Freixa
authors.forename: Neus
authors.initials: N
authors.lastname: Bellera
authors.forename: José T
authors.initials: JT
authors.lastname: Ortiz-Pérez
authors.forename: Marcelo
authors.initials: M
authors.lastname: Jiménez
authors.forename: Carles
authors.initials: C
authors.lastname: Paré
authors.forename: Xavier
authors.initials: X
authors.lastname: Bosch
authors.forename: Teresa M
authors.initials: TM
authors.lastname: De Caralt
authors.forename: Amadeo
authors.initials: A
authors.lastname: Betriu
authors.forename: Mónica
authors.initials: M
authors.lastname: Masotti
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D057775:Ischemic Postconditioning / Q000379:methods; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D011446:Prospective Studies; D016879:Salvage Therapy / Q000379:methods; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome