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.

Autor: Bodi V; Cardiology Department, Hospital Clinico Universitario-INCLIVA, University of Valencia, Valencia, Spain. Electronic address: vicentbodi@hotmail.com., Ruiz-Nodar JM; Cardiology Department, Hospital General Universitario, Alicante, Spain., Feliu E; Magnetic Resonance Unit, INSCANNER SL, Hospital General Universitario, Alicante, Spain., Minana G; Cardiology Department, Hospital Clinico Universitario-INCLIVA, University of Valencia, Valencia, Spain., Nunez J; Cardiology Department, Hospital Clinico Universitario-INCLIVA, University of Valencia, Valencia, Spain., Husser O; Klinik für Herz und Kreislauferkrankungen, Deutsches Herzzentrum, Munich, Germany., Martinez-Elvira J; Cardiology Department, Hospital General Universitario, Alicante, Spain., Ruiz A; University of Valencia-INCLIVA, Valencia, Spain., Bonanad C; Cardiology Department, Hospital Clinico Universitario-INCLIVA, University of Valencia, Valencia, Spain., Monmeneu JV; Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain., Lopez-Lereu MP; Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain., Forteza MJ; Cardiology Department, Hospital Clinico Universitario-INCLIVA, University of Valencia, Valencia, Spain., de Dios E; Cardiology Department, Hospital Clinico Universitario-INCLIVA, University of Valencia, Valencia, Spain., Hervas A; Cardiology Department, Hospital Clinico Universitario-INCLIVA, University of Valencia, Valencia, Spain., Moratal D; Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain., Gomez C; Cardiology Department, Hospital Clinico Universitario-INCLIVA, University of Valencia, Valencia, Spain., Mainar L; Cardiology Department, Hospital Clinico Universitario-INCLIVA, University of Valencia, Valencia, Spain., Sanchis J; Cardiology Department, Hospital Clinico Universitario-INCLIVA, University of Valencia, Valencia, Spain., Mainar V; Cardiology Department, Hospital General Universitario, Alicante, Spain., Valencia J; Cardiology Department, Hospital General Universitario, Alicante, Spain., Diaz A; University of Valencia-INCLIVA, Valencia, Spain., Noguera I; University of Valencia-INCLIVA, Valencia, Spain., Chaustre F; Cardiology Department, Hospital Clinico Universitario-INCLIVA, University of Valencia, Valencia, Spain., Chorro FJ; Cardiology Department, Hospital Clinico Universitario-INCLIVA, University of Valencia, Valencia, Spain.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2014 Jul 15; Vol. 175 (1), pp. 138-46. Date of Electronic Publication: 2014 May 10.
DOI: 10.1016/j.ijcard.2014.05.003
Abstrakt: 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.
(Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)
Databáze: MEDLINE
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