title: Lack of Benefit of Ischemic Postconditioning After Routine Thrombus Aspiration During Reperfusion: Immediate and Midterm Results.
abstract: OBJECTIVE
  The underutilization of manual thrombus aspiration (MTA) may have reduced the benefits of ischemic postconditioning (PostCon), as it reduces thrombus embolization. We aimed to assess the benefits of PostCon in patients with ST-segment elevation myocardial infarction (STEMI) after the systematic utilization of MTA.
  
  
  METHODS
  A total of 87 patients were enrolled in a prospective, randomized trial (43 PostCon and 44 controls). After MTA, PostCon was performed on the treatment group by applying 4 cycles of alternate reperfusion and reocclusion (60 seconds each) using the angioplasty balloon. The primary end point was infarct size assessed by the area under the curve (AUC) of troponin T (TnT) activity. The secondary end points were left ventricle ejection fraction (LVEF) and major cardiac events (new myocardial infarction or cardiac death) both at discharge and at follow-up.
  
  
  RESULTS
  The AUC for TnT was no different with respect to study arms (median [interquartile range]): PostCon = 8.9 (10.6) versus control = 8.2 (10.6), P = .68. Left ventricle ejection fraction improved from in-hospital to follow-up (9 ± 3 months) for the entire cohort (46.3% ± 7.3% vs 52.2% ± 10.7%, P < .001), with no differences between PostCon and controls (51.6% ± 9.5% vs 52.7% ± 11.9%, P = .89); major cardiac events at 14 ± 4 months of follow-up were also no different (PostCon = 1.0 (2.3%) vs control = 0, P = .49).
  
  
  CONCLUSIONS
  In patients with STEMI treated with MTA, PostCon offered no benefits to infarct size, LVEF, or major cardiac events.
authors.affiliation: Cardiology Department, Porto Hospital Centre, Porto, Portugal andrecoimbraluz@hotmail.com.
authors.forename: André
authors.initials: A
authors.lastname: Luz
authors.affiliation: Cardiology Department, Porto Hospital Centre, Porto, Portugal Department of Physiology and Cardio-Thoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: Mário
authors.initials: M
authors.lastname: Santos
authors.affiliation: Institute of Biomedical Sciences "Abel Salazar," University of Porto, Porto, Portugal.
authors.forename: Rui
authors.initials: R
authors.lastname: Magalhães
authors.affiliation: Cardiology Department, Porto Hospital Centre, Porto, Portugal Institute of Biomedical Sciences "Abel Salazar," University of Porto, Porto, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Silveira
authors.affiliation: Cardiology Department, Porto Hospital Centre, Porto, Portugal.
authors.forename: Sofia
authors.initials: S
authors.lastname: Cabral
authors.affiliation: Cardiology Department, Porto Hospital Centre, Porto, Portugal.
authors.forename: Vasco
authors.initials: V
authors.lastname: Dias
authors.affiliation: Cardiology Department, Porto Hospital Centre, Porto, Portugal.
authors.forename: Filomena
authors.initials: F
authors.lastname: Oliveira
authors.affiliation: Cardiology Department, Porto Hospital Centre, Porto, Portugal.
authors.forename: Sousa
authors.initials: S
authors.lastname: Pereira
authors.affiliation: Department of Physiology and Cardio-Thoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: Adelino
authors.initials: A
authors.lastname: Leite-Moreira
authors.affiliation: Cardiology Department, Porto Hospital Centre, Porto, Portugal Institute of Biomedical Sciences "Abel Salazar," University of Porto, Porto, Portugal.
authors.forename: Henrique
authors.initials: H
authors.lastname: Carvalho
authors.affiliation: Cardiology Department, Porto Hospital Centre, Porto, Portugal Institute of Biomedical Sciences "Abel Salazar," University of Porto, Porto, Portugal.
authors.forename: Severo
authors.initials: S
authors.lastname: Torres
mesh_terms: D000368:Aged; D003328:Coronary Thrombosis / Q000628:therapy*; D016757:Death, Sudden, Cardiac; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D057775:Ischemic Postconditioning / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology / Q000628:therapy; D015425:Myocardial Reperfusion; D011446:Prospective Studies; D013318:Stroke Volume; D017131:Thrombectomy / Q000379:methods*; D020107:Troponin T / Q000097:blood; D016277:Ventricular Function, Left
chemical_list: D020107:Troponin T
keywords: ST-segment elevation myocardial infarction; manual thrombectomy; postconditioning