Post-conditioning reduces infarct size and edema in patients with ST-segment elevation myocardial infarction.
OBJECTIVE
This study aimed to determine whether post-conditioning at the time of percutaneous coronary intervention could reduce reperfusion-induced myocardial edema in patients with acute ST-segment elevation myocardial infarction (STEMI).


BACKGROUND
Myocardial edema is a reperfusion injury with potentially severe consequences. Post-conditioning is a cardioprotective therapy that reduces infarct size after reperfusion, but no previous studies have analyzed the impact of this strategy on reperfusion-induced myocardial edema in humans.


METHODS
Fifty patients with STEMI were randomly assigned to either a control or post-conditioned group. Cardiac magnetic resonance imaging was performed within 48 to 72 h after admission. Myocardial edema was measured by T2-weighted sequences, and infarct size was determined by late gadolinium enhancement sequences and creatine kinase release.


RESULTS
The post-conditioned and control groups were similar with respect to ischemia time, the size of the area at risk, and the ejection fraction before percutaneous coronary intervention. As expected, post-conditioning was associated with smaller infarct size (13 ± 7 g/m(2) vs. 21 ± 14 g/m(2); p = 0.01) and creatine kinase peak serum level (median [interquartile range]: 1,695 [1,118 to 3,692] IU/l vs. 3,505 [2,307 to 4,929] IU/l; p = 0.003). At reperfusion, the extent of myocardial edema was significantly reduced in the post-conditioned group as compared with the control group (23 ± 16 g/m(2) vs. 34 ± 18 g/m(2); p = 0.03); the relative increase in T2W signal intensity was also significantly lower (p = 0.02). This protective effect was confirmed after adjustment for the size of the area at risk.


CONCLUSIONS
This randomized study demonstrated that post-conditioning reduced infarct size and edema in patients with reperfused STEMI.
CREATIS, CNRS UMR 5220, INSERM U1044, Université de Lyon, Lyon, France. franck.thuny@gmail.com
Franck
F
Thuny
Olivier
O
Lairez
François
F
Roubille
Nathan
N
Mewton
Gilles
G
Rioufol
Catherine
C
Sportouch
Ingrid
I
Sanchez
Cyrille
C
Bergerot
Hélène
H
Thibault
Thien Tri
TT
Cung
Gérard
G
Finet
Laurent
L
Argaud
Didier
D
Revel
Geneviève
G
Derumeaux
Eric
E
Bonnefoy-Cudraz
Meier
M
Elbaz
Christophe
C
Piot
Michel
M
Ovize
Pierre
P
Croisille
D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D004487:Edema / Q000517:prevention & control; D005260:Female; D006801:Humans; D057775:Ischemic Postconditioning; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology / Q000628:therapy*; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D055815:Young Adult