Influence of cardiovascular risk factors on infarct size and interaction with mechanical ischaemic postconditioning in ST-elevation myocardial infarction.
Previous studies have shown that mechanical postconditioning (PostC) significantly reduces infarct size (IS) in patients with acute myocardial infarction. Our objective was to assess the influence of traditional cardiovascular (CV) risk factors on IS and their interaction with ischaemic PostC in patients with acute ST-elevation myocardial infarction (STEMI).



The study population was constituted from the clinical database pooling of four previously published PostC prospective, multicentre, randomised, open-label controlled trials with identical inclusion criteria. Patients with STEMI, presenting within 12 h of symptoms onset referred for percutaneous coronary intervention, were included. Mechanical ischaemic PostC was performed by four repeated cycles of inflation-deflation of the angioplasty balloon within 1 min of reflow, while the control group underwent no intervention. IS was assessed by measuring total creatine kinase release over 72 h.



173 patients, aged 58±12 years, 76% males, 48% anterior infarct were included (82 in the PostC group, 91 in the control group). IS was significantly reduced in the PostC compared to the control group (71.7±41.6 vs 88.2±54.5×10(3) arbitrary units; p=0.027). After adjustment for abnormally contracting segments, older patients had smaller IS and smokers had larger IS. Gender, diabetes, hypertension, dyslipidemia and obesity did not have any significant effect on IS. Multivariate regression analysis showed that none of the traditional risk factors had a significant impact on the cardioprotective effect of mechanical ischaemic PostC.



The present analysis suggests that the cardioprotective effect of mechanical PostC is not influenced by traditional CV risk factors that are prevalent in patients with STEMI.
Cardiology Division , Hôpital Cardiologique Louis Pradel, Centre d'Investigation Clinique, Hospices Civils de Lyon , Lyon , France.
Sophie
S
Pichot
Cardiology Division , Hôpital Cardiologique Louis Pradel, Centre d'Investigation Clinique, Hospices Civils de Lyon , Lyon , France ; Inserm UMR-1060, CarMeN Unit , Université Claude Bernard Lyon1 , Lyon , France.
Nathan
N
Mewton
CHRU Tours, Service de Pharmacologie, Hôpital Bretonneau; CNRS UMR 7292, Université François Rabelais, GICC , Tours , France.
Theodora
T
Bejan-Angoulvant
Cardiology Division , Hôpital Cardiologique Louis Pradel, Centre d'Investigation Clinique, Hospices Civils de Lyon , Lyon , France.
Francois
F
Roubille
Cardiology Division , Hôpital Cardiologique Louis Pradel, Centre d'Investigation Clinique, Hospices Civils de Lyon , Lyon , France ; Inserm UMR-1060, CarMeN Unit , Université Claude Bernard Lyon1 , Lyon , France.
Gilles
G
Rioufol
Cardiology Division , Hôpital Cardiologique Louis Pradel, Centre d'Investigation Clinique, Hospices Civils de Lyon , Lyon , France.
Céline
C
Giraud
Cardiology Division , Hôpital Cardiologique Louis Pradel, Centre d'Investigation Clinique, Hospices Civils de Lyon , Lyon , France.
Inesse
I
Boussaha
Hôpital Rangueuil, Université Paul Sabatier , Toulouse , France.
Olivier
O
Lairez
Hôpital Rangueuil, Université Paul Sabatier , Toulouse , France.
Meyer
M
Elbaz
Hopital Arnaud de Villeneuve, Université de Montpellier I and II , Montpellier , France ; Inserm U661 , Montpellier , France.
Christophe
C
Piot
CHRU Tours, Hôpital Trousseau, Université François Rabelais EA 4245 , Tours , France.
Denis
D
Angoulvant
Cardiology Division , Hôpital Cardiologique Louis Pradel, Centre d'Investigation Clinique, Hospices Civils de Lyon , Lyon , France ; Inserm UMR-1060, CarMeN Unit , Université Claude Bernard Lyon1 , Lyon , France.
Michel
M
Ovize