title: No post-conditioning in the human heart with thrombolysis in myocardial infarction flow 2-3 on admission.
abstract: OBJECTIVE
  Proof-of-concept evidence suggests that mechanical ischaemic post-conditioning (PostC) reduces infarct size when applied immediately after culprit coronary artery re-opening in ST-elevation myocardial infarction (STEMI) patients with thrombolysis in myocardial infarction 0-1 (TIMI 0-1) flow grade at admission. Whether PostC might also be protective in patients with a TIMI 2-3 flow grade on admission (corresponding to a delayed application of the post-conditioning algorithm) remains undetermined.
  
  
  RESULTS
  In this multi-centre, randomized, single-blinded, controlled study, STEMI patients with a 2-3 TIMI coronary flow grade at admission underwent direct stenting of the culprit lesion, followed (PostC group) or not (control group) by four cycles of (1 min inflation/1 min deflation) of the angioplasty balloon to trigger post-conditioning. Infarct size was assessed both by cardiac magnetic resonance at Day 5 (primary endpoint) and cardiac enzymes release (secondary endpoint). Ninety-nine patients were prospectively enrolled. Baseline characteristics were comparable between control and PostC groups. Despite comparable size of area at risk (AAR) (38 ± 12 vs. 38 ± 13% of the LV circumference, respectively, P = 0.89) and similar time from onset to intervention (249 ± 148 vs. 263 ± 209 min, respectively, P = 0.93) in the two groups, PostC did not significantly reduce cardiac magnetic resonance infarct size (23 ± 17 and 21 ± 18 g in the treated vs. control group, respectively, P = 0.64). Similar results were found when using creatine kinase and troponin I release, even after adjustment for the size of the AAR.
  
  
  CONCLUSIONS
  This study shows that infarct size reduction by mechanical ischaemic PostC is lost when applied to patients with a TIMI 2-3 flow grade at admission. This indicates that the timing of the protective intervention with respect to the onset of reperfusion is a key factor for preventing lethal reperfusion injury in STEMI patients.
  
  
  BACKGROUND
  NCT01483755.
authors.affiliation: Department of Cardiology, UMR5203, UMR661, Institut de Génomique Fonctionnelle, Universités Montpellier 1 and 2, Montpellier, France Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada H3T 1J4.
authors.forename: F
authors.initials: F
authors.lastname: Roubille
authors.affiliation: Service D'Explorations Fonctionnelles Cardiovasculaires, Hôpital Louis Pradel, 59 Bd Pinel, Lyon Cedex 03 69394, INSERM CIC1407, CHU Lyon, F-69000 France Inserm U1060-CarMeN, Université Claude Bernard Lyon1, Lyon, Villeurbanne 69394, INSERM CIC1407, CHU Lyon, F-69000 France.
authors.forename: N
authors.initials: N
authors.lastname: Mewton
authors.affiliation: Service de Cardiologie, Hôpital Rangeuil, Université Paul Sabatier, Toulouse 31059, France.
authors.forename: M
authors.initials: M
authors.lastname: Elbaz
authors.affiliation: Hôpital Emile Müller, 20 Avenue du Dr René Laennec, Mulhouse Cedex 68051, France.
authors.forename: O
authors.initials: O
authors.lastname: Roth
authors.affiliation: L'UNAM Université, Université Angers, Laboratoire Cardioprotection, Remodelage et Thrombose, and CHU Angers, Service de Cardiologie, Angers, France.
authors.forename: F
authors.initials: F
authors.lastname: Prunier
authors.affiliation: Department of Cardiology, UMR5203, UMR661, Institut de Génomique Fonctionnelle, Universités Montpellier 1 and 2, Montpellier, France.
authors.forename: T T
authors.initials: TT
authors.lastname: Cung
authors.affiliation: Department of Cardiology, UMR5203, UMR661, Institut de Génomique Fonctionnelle, Universités Montpellier 1 and 2, Montpellier, France.
authors.forename: C
authors.initials: C
authors.lastname: Piot
authors.affiliation: Service de Cardiologie, Hôpital Rangeuil, Université Paul Sabatier, Toulouse 31059, France.
authors.forename: J
authors.initials: J
authors.lastname: Roncalli
authors.affiliation: Service D'Explorations Fonctionnelles Cardiovasculaires, Hôpital Louis Pradel, 59 Bd Pinel, Lyon Cedex 03 69394, INSERM CIC1407, CHU Lyon, F-69000 France Inserm U1060-CarMeN, Université Claude Bernard Lyon1, Lyon, Villeurbanne 69394, INSERM CIC1407, CHU Lyon, F-69000 France.
authors.forename: G
authors.initials: G
authors.lastname: Rioufol
authors.affiliation: Service D'Explorations Fonctionnelles Cardiovasculaires, Hôpital Louis Pradel, 59 Bd Pinel, Lyon Cedex 03 69394, INSERM CIC1407, CHU Lyon, F-69000 France Inserm U1060-CarMeN, Université Claude Bernard Lyon1, Lyon, Villeurbanne 69394, INSERM CIC1407, CHU Lyon, F-69000 France.
authors.forename: E
authors.initials: E
authors.lastname: Bonnefoy-Cudraz
authors.affiliation: Hôpital Emile Müller, 20 Avenue du Dr René Laennec, Mulhouse Cedex 68051, France.
authors.forename: J Y
authors.initials: JY
authors.lastname: Wiedemann
authors.affiliation: L'UNAM Université, Université Angers, Laboratoire Cardioprotection, Remodelage et Thrombose, and CHU Angers, Service de Cardiologie, Angers, France.
authors.forename: A
authors.initials: A
authors.lastname: Furber
authors.affiliation: Hôpital Emile Müller, 20 Avenue du Dr René Laennec, Mulhouse Cedex 68051, France.
authors.forename: L
authors.initials: L
authors.lastname: Jacquemin
authors.affiliation: L'UNAM Université, Université Angers, Laboratoire Cardioprotection, Remodelage et Thrombose, and CHU Angers, Service de Cardiologie, Angers, France.
authors.forename: S
authors.initials: S
authors.lastname: Willoteaux
authors.affiliation: L'UNAM Université, Université Angers, Laboratoire Cardioprotection, Remodelage et Thrombose, and CHU Angers, Service de Cardiologie, Angers, France.
authors.forename: W
authors.initials: W
authors.lastname: Abi-Khallil
authors.affiliation: Service D'Explorations Fonctionnelles Cardiovasculaires, Hôpital Louis Pradel, 59 Bd Pinel, Lyon Cedex 03 69394, INSERM CIC1407, CHU Lyon, F-69000 France Inserm U1060-CarMeN, Université Claude Bernard Lyon1, Lyon, Villeurbanne 69394, INSERM CIC1407, CHU Lyon, F-69000 France.
authors.forename: I
authors.initials: I
authors.lastname: Sanchez
authors.affiliation: Service D'Explorations Fonctionnelles Cardiovasculaires, Hôpital Louis Pradel, 59 Bd Pinel, Lyon Cedex 03 69394, INSERM CIC1407, CHU Lyon, F-69000 France Inserm U1060-CarMeN, Université Claude Bernard Lyon1, Lyon, Villeurbanne 69394, INSERM CIC1407, CHU Lyon, F-69000 France.
authors.forename: G
authors.initials: G
authors.lastname: Finet
authors.affiliation: Service D'Explorations Fonctionnelles Cardiovasculaires, Hôpital Louis Pradel, 59 Bd Pinel, Lyon Cedex 03 69394, INSERM CIC1407, CHU Lyon, F-69000 France Inserm U1060-CarMeN, Université Claude Bernard Lyon1, Lyon, Villeurbanne 69394, INSERM CIC1407, CHU Lyon, F-69000 France.
authors.forename: F
authors.initials: F
authors.lastname: Sibellas
authors.affiliation: Service D'Explorations Fonctionnelles Cardiovasculaires, Hôpital Louis Pradel, 59 Bd Pinel, Lyon Cedex 03 69394, INSERM CIC1407, CHU Lyon, F-69000 France Inserm U1060-CarMeN, Université Claude Bernard Lyon1, Lyon, Villeurbanne 69394, INSERM CIC1407, CHU Lyon, F-69000 France.
authors.forename: S
authors.initials: S
authors.lastname: Ranc
authors.affiliation: Service D'Explorations Fonctionnelles Cardiovasculaires, Hôpital Louis Pradel, 59 Bd Pinel, Lyon Cedex 03 69394, INSERM CIC1407, CHU Lyon, F-69000 France Inserm U1060-CarMeN, Université Claude Bernard Lyon1, Lyon, Villeurbanne 69394, INSERM CIC1407, CHU Lyon, F-69000 France.
authors.forename: I
authors.initials: I
authors.lastname: Boussaha
authors.affiliation: CHU Saint-Etienne, CREATIS, CNRS UMR 5220, INSERM U1044, Université Jean Monnet, Université de Lyon, France.
authors.forename: P
authors.initials: P
authors.lastname: Croisille
authors.affiliation: Service D'Explorations Fonctionnelles Cardiovasculaires, Hôpital Louis Pradel, 59 Bd Pinel, Lyon Cedex 03 69394, INSERM CIC1407, CHU Lyon, F-69000 France Inserm U1060-CarMeN, Université Claude Bernard Lyon1, Lyon, Villeurbanne 69394, INSERM CIC1407, CHU Lyon, F-69000 France Hôpital Cardiologique Louis Pradel, Centre d'Investigation Clinique & Service d'Explorations Fonctionnelles Cardiovasculaires, Hospices Civils de Lyon, 59 Bd Pinel, Lyon Cedex 03 69394, INSERM CIC1407, CHU Lyon, F-69000 France michel.ovize@chu-lyon.fr.
authors.forename: M
authors.initials: M
authors.lastname: Ovize
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D054059:Coronary Occlusion / Q000473:pathology / Q000628:therapy; D003402:Creatine Kinase / Q000378:metabolism; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D057775:Ischemic Postconditioning / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods*; D016037:Single-Blind Method; D015607:Stents; D016896:Treatment Outcome; D014336:Troponin / Q000378:metabolism; D055815:Young Adult
chemical_list: D015415:Biomarkers; D005343:Fibrinolytic Agents; D014336:Troponin; D003402:Creatine Kinase
keywords: Acute coronary syndrome; Cardioprotection; Myocardial infarction; Post-conditioning