Abstract 4494: Attenuation of TNF-α Elevation and Ventricular Aneurysm by Postconditioning-60 Second in Patients with Acute Myocardial Infarction
Background We have reported that postconditioning (Postcon) reduces infarct size in patients with acute myocardial infarction. This study tested the hypothesis that Postcon 60 second (Postcon-60s) decreases Tumor Necrosis Factor-α (TNF-α) elevation and attenuates ventricular aneurysm formation in patients with undergoing Percutaneous Coronary Intervention (PCI).
Methods and Results Sixty-one patients with Acute Myocardial Infarction (AMI) were randomly assigned to Routine (n=31) and Postcon-60s (n=30) groups. 30 normal volunteers were enrolled in the study. In the Routine group, no intervention was given at the onset of reperfusion before stenting, while in the Postcon-60s group, three cycles of 60s angioplasty balloon inflation and 60s deflation was respectively performed at onset of reperfusion. Serum TNF-α concentration was measured by ELISA assay and ventricular aneurysm formation was determined by echocardiography. TNF-α serum concentration was significantly higher in all patients after admission than that in the normal volunteers (30±10* vs.17±2 pg/ml), which was comparable between Routine and Postcon-60s groups. However, TNF-α concentration was significantly increased in the Routine group after 24h (39±13**pg/ml) with a persistent elevation at 7d (37±13**pg/ml). This change in TNF-α concentration was significantly attenuated by Postcon-60s at these time points relative to the Routine group (28±8† and 27±3†pg/ml), respectively. Along with these changes, the formations of ventricular aneurysm in Postcon-60s group were significantly attenuated relative to the Routine patients at 7d of reperfusion (5.0%† vs.29.6%).
Conclusion Application of Postcon-60s during PCI decrease serum TNF-α concentration and reduces ventricular aneurysm formation in patients with AMI. More importantly, our study indicates that protection with Postcon-60s is still preserved after an extended reperfusion, suggesting a persistent protection. (*p<0.05 Routine vs. Normal; **p<0.05 Routine vs. baseline; †p<0.05 Postcon-60s vs. Routine).