Ischemic Postconditioning during Primary Percutaneous Coronary Intervention: The POST Randomized Trial
Background—Ischemic postconditioning has been reported to reduce infarct size in patients with ST-segment elevation myocardial infarction (STEMI). However, cardioprotective effects of postconditioning have not been demonstrated in a large-scale trial.
Methods and Results—We performed a multicenter, prospective, randomized, open-label, blinded endpoint trial. A total of 700 patients undergoing primary percutaneous coronary intervention (PCI) for STEMI within 12 hours after symptom onset were randomly assigned to the postconditioning group or the conventional primary PCI group in a 1:1 ratio. Postconditioning was performed immediately after restoration of coronary flow as follows: the angioplasty balloon was positioned at the culprit lesion, and inflated 4 times for 1 minute with low-pressure (< 6 atm) inflations, each separated by 1 minute of deflation. The primary endpoint was complete ST-segment resolution (the percentage resolution of ST-segment elevation >70%) measured at 30 minutes after PCI. Complete ST-segment resolution occurred in 40.5% of patients in the postconditioning group and 41.5% of patients in the conventional PCI group (absolute difference, -1.0%; 95% confidence interval, -8.4% to 6.4%; P=0.79). The rate of myocardial blush grade of 0 or 1 and the major adverse cardiac events (a composite of death, myocardial infarction, severe heart failure, or stent thrombosis) at 30 days did not differ significantly between the postconditioning group and the conventional PCI group (17.2% versus 22.4%, P=0.20, and 4.3% versus 3.7%, P=0.70, respectively).
Conclusions—Ischemic postconditioning did not improve myocardial reperfusion in patients with STEMI undergoing primary PCI with current standard practice.
Clinical Trial Registration Information—http://ClinicalTrials.gov. Identifier: NCT00942500.
- ST-segment elevation myocardial infarction
- primary percutaneous coronary intervention
- Received January 29, 2013.
- Revision received August 6, 2013.
- Accepted August 14, 2013.