title: Effect of ischemic postconditioning on microvascular obstruction in reperfused myocardial infarction. Results of a randomized study in patients and of an experimental model in swine.
abstract: BACKGROUND
  Ischemic postconditioning (PCON) appears as a potentially beneficial tool in ST-segment elevation myocardial infarction (STEMI). We evaluated the effect of PCON on microvascular obstruction (MVO) in STEMI patients and in an experimental swine model.
  
  
  METHODS
  A prospective randomized study in patients and an experimental study in swine were carried out in two university hospitals in Spain. 101 consecutive STEMI patients were randomized to undergo primary angioplasty followed by PCON or primary angioplasty alone (non-PCON). Using late gadolinium enhancement cardiovascular magnetic resonance, infarct size and MVO were quantified (% of left ventricular mass). In swine, using an angioplasty balloon-induced anterior STEMI model, MVO was defined as the % of area at risk without thioflavin-S staining.
  
  
  RESULTS
  In patients, PCON (n=49) in comparison with non-PCON (n=52) did not significantly reduce MVO (0 [0-1.02]% vs. 0 [0-2.1]% p=0.2) or IS (18 ± 13% vs. 21 ± 14%, p=0.2). MVO (>1 segment in the 17-segment model) occurred in 12/49 (25%) PCON and in 18/52 (35%) non-PCON patients, p=0.3. No significant differences were observed between PCON and non-PCON patients in left ventricular volumes, ejection fraction or the extent of hemorrhage. In the swine model, MVO occurred in 4/6 (67%) PCON and in 4/6 (67%) non-PCON pigs, p=0.9. The extent of MVO (10 ± 7% vs. 10 ± 8%, p=0.9) and infarct size (23 ± 14% vs. 24 ± 10%, p=0.8) was not reduced in PCON compared with non-PCON pigs.
  
  
  CONCLUSIONS
  Ischemic postconditioning does not significantly reduce microvascular obstruction in ST-segment elevation myocardial infarction. Clinical Trial Registration http://www.clinicaltrials.gov. Unique identifier: NCT01898546.
authors.affiliation: Cardiology Department, Hospital Clinico Universitario-INCLIVA, University of Valencia, Valencia, Spain. Electronic address: vicentbodi@hotmail.com.
authors.forename: Vicente
authors.initials: V
authors.lastname: Bodi
authors.affiliation: Cardiology Department, Hospital General Universitario, Alicante, Spain.
authors.forename: Juan M
authors.initials: JM
authors.lastname: Ruiz-Nodar
authors.affiliation: Magnetic Resonance Unit, INSCANNER SL, Hospital General Universitario, Alicante, Spain.
authors.forename: Eloisa
authors.initials: E
authors.lastname: Feliu
authors.affiliation: Cardiology Department, Hospital Clinico Universitario-INCLIVA, University of Valencia, Valencia, Spain.
authors.forename: Gema
authors.initials: G
authors.lastname: Minana
authors.affiliation: Cardiology Department, Hospital Clinico Universitario-INCLIVA, University of Valencia, Valencia, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Nunez
authors.affiliation: Klinik für Herz und Kreislauferkrankungen, Deutsches Herzzentrum, Munich, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Husser
authors.affiliation: Cardiology Department, Hospital General Universitario, Alicante, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Martinez-Elvira
authors.affiliation: University of Valencia-INCLIVA, Valencia, Spain.
authors.forename: Amparo
authors.initials: A
authors.lastname: Ruiz
authors.affiliation: Cardiology Department, Hospital Clinico Universitario-INCLIVA, University of Valencia, Valencia, Spain.
authors.forename: Clara
authors.initials: C
authors.lastname: Bonanad
authors.affiliation: Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain.
authors.forename: Jose V
authors.initials: JV
authors.lastname: Monmeneu
authors.affiliation: Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain.
authors.forename: Maria P
authors.initials: MP
authors.lastname: Lopez-Lereu
authors.affiliation: Cardiology Department, Hospital Clinico Universitario-INCLIVA, University of Valencia, Valencia, Spain.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Forteza
authors.affiliation: Cardiology Department, Hospital Clinico Universitario-INCLIVA, University of Valencia, Valencia, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: de Dios
authors.affiliation: Cardiology Department, Hospital Clinico Universitario-INCLIVA, University of Valencia, Valencia, Spain.
authors.forename: Arantxa
authors.initials: A
authors.lastname: Hervas
authors.affiliation: Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Moratal
authors.affiliation: Cardiology Department, Hospital Clinico Universitario-INCLIVA, University of Valencia, Valencia, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Gomez
authors.affiliation: Cardiology Department, Hospital Clinico Universitario-INCLIVA, University of Valencia, Valencia, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Mainar
authors.affiliation: Cardiology Department, Hospital Clinico Universitario-INCLIVA, University of Valencia, Valencia, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.affiliation: Cardiology Department, Hospital General Universitario, Alicante, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Mainar
authors.affiliation: Cardiology Department, Hospital General Universitario, Alicante, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Valencia
authors.affiliation: University of Valencia-INCLIVA, Valencia, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Diaz
authors.affiliation: University of Valencia-INCLIVA, Valencia, Spain.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Noguera
authors.affiliation: Cardiology Department, Hospital Clinico Universitario-INCLIVA, University of Valencia, Valencia, Spain.
authors.forename: Fabian
authors.initials: F
authors.lastname: Chaustre
authors.affiliation: Cardiology Department, Hospital Clinico Universitario-INCLIVA, University of Valencia, Valencia, Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Chorro
mesh_terms: D000368:Aged; D000818:Animals; D004195:Disease Models, Animal; D005260:Female; D006801:Humans; D057775:Ischemic Postconditioning / Q000379:methods / Q000639:trends*; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods / Q000639:trends*; D011446:Prospective Studies; D013552:Swine; D016896:Treatment Outcome
keywords: Ischemic postconditioning; Myocardial infarction; Perfusion