No post-conditioning in the human heart with thrombolysis in myocardial infarction flow 2-3 on admission

Autor: Ingrid Sanchez, Meyer Elbaz, O. Roth, Christophe Piot, Serge Willoteaux, T.T. Cung, Jerome Roncalli, Alain Furber, F. Sibellas, Inesse Boussaha, Michel Ovize, François Roubille, Pierre Croisille, L. Jacquemin, J.-Y. Wiedemann, Gérard Finet, S. Ranc, Fabrice Prunier, Nathan Mewton, Gilles Rioufol, W. Abi-Khallil, Eric Bonnefoy-Cudraz
Přispěvatelé: Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), RMN et optique : De la mesure au biomarqueur, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)
Rok vydání: 2014
Předmět:
Adult
Male
Acute coronary syndrome
medicine.medical_specialty
medicine.medical_treatment
Troponin/metabolism
[SDV]Life Sciences [q-bio]
Myocardial Infarction
Infarction
Myocardial Reperfusion
Biomarkers/metabolism
Young Adult
Reperfusion therapy
Fibrinolytic Agents
Angioplasty
Internal medicine
Coronary Occlusion/pathology/therapy
medicine
Humans
Single-Blind Method
Myocardial infarction
cardiovascular diseases
Ischemic Postconditioning
Creatine Kinase
ComputingMilieux_MISCELLANEOUS
Aged
business.industry
Fibrinolytic Agents/therapeutic use
Thrombolysis
Middle Aged
medicine.disease
Troponin
3. Good health
Myocardial Reperfusion/*methods
Treatment Outcome
Coronary Occlusion
Coronary occlusion
Cardiology
Ischemic Postconditioning/*methods
Female
Stents
Creatine Kinase/metabolism
Cardiology and Cardiovascular Medicine
business
TIMI
Biomarkers
Myocardial Infarction/pathology/*therapy
Zdroj: Eur Heart J
Eur Heart J, 2014, 35 (25), pp.1675-82. ⟨10.1093/eurheartj/ehu054⟩
European Heart Journal
European Heart Journal, Oxford University Press (OUP): Policy B, 2014, 35 (25), pp.1675-82. ⟨10.1093/eurheartj/ehu054⟩
ISSN: 1522-9645
0195-668X
DOI: 10.1093/eurheartj/ehu054⟩
Popis: International audience; AIMS: 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. METHODS AND 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. CONCLUSION: 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. CLINICAL TRIAL NUMBER: NCT01483755.
Databáze: OpenAIRE
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