title: Postconditioning attenuates no-reflow in STEMI patients.
abstract: After acute myocardial infarction, the presence of no-reflow (or microvascular obstruction: MVO) has been associated with adverse left ventricular (LV) remodeling and worse clinical outcome. This study examined the effects of mechanical ischemic postconditioning on early and late MVO size in acute ST-elevation myocardial infarction (STEMI) patients. Fifty patients undergoing primary coronary angioplasty for a first STEMI with TIMI grade flow 0-1 and no collaterals were randomized to ischemic postconditioning (PC) (n = 25) or control (n = 25) groups. Ischemic PC consisted in the application of four consecutive cycles of a 1-min balloon occlusion, each followed by a 1-min deflation at the onset of reperfusion. Early (3 min post-contrast) and late (10 min post-contrast) MVO size were assessed by contrast-enhanced cardiac-MRI within 96 h after reperfusion. PC was associated with smaller early and late MVO size (3.9 ± 4.8 in PC versus 7.8 ± 6.6% of LV in controls for early MVO, P = 0.02; and 1.8 ± 3.1 in PC versus 4.1 ± 3.9% of LV in controls for late MVO; P = 0.01). This significant reduction was persistent after adjustment for thrombus aspiration, which neither had any significant effect on infarct size, nor on early or late MVO (P = NS for all). Attenuation of MVO was associated to infarct size reduction. Mechanical postconditioning significantly reduces MVO in patients with acute STEMI treated with primary angioplasty.
authors.affiliation: Cardiology Division, Centre d'Investigation Clinique de Lyon (CIC), Groupement Hospitalier Est, Hôpital Louis Pradel, Hospices Civils de Lyon, 28 avenue Doyen Lépine, 69677, Bron, France, nathan.mewton@chu-lyon.fr.
authors.forename: Nathan
authors.initials: N
authors.lastname: Mewton
authors.forename: Hélène
authors.initials: H
authors.lastname: Thibault
authors.forename: François
authors.initials: F
authors.lastname: Roubille
authors.forename: Olivier
authors.initials: O
authors.lastname: Lairez
authors.forename: Gilles
authors.initials: G
authors.lastname: Rioufol
authors.forename: Catherine
authors.initials: C
authors.lastname: Sportouch
authors.forename: Ingrid
authors.initials: I
authors.lastname: Sanchez
authors.forename: Cyrille
authors.initials: C
authors.lastname: Bergerot
authors.forename: Thien Tri
authors.initials: TT
authors.lastname: Cung
authors.forename: Gérard
authors.initials: G
authors.lastname: Finet
authors.forename: Denis
authors.initials: D
authors.lastname: Angoulvant
authors.forename: Didier
authors.initials: D
authors.lastname: Revel
authors.forename: Eric
authors.initials: E
authors.lastname: Bonnefoy-Cudraz
authors.forename: Meyer
authors.initials: M
authors.lastname: Elbaz
authors.forename: Christophe
authors.initials: C
authors.lastname: Piot
authors.forename: Inesse
authors.initials: I
authors.lastname: Sahraoui
authors.forename: Pierre
authors.initials: P
authors.lastname: Croisille
authors.forename: Michel
authors.initials: M
authors.lastname: Ovize
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D057775:Ischemic Postconditioning / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome