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No benefit noted with postconditioning after primary PCI
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MIAMI — New data from the POST trial demonstrate that ischemic postconditioning after primary PCI did not improve myocardial reperfusion or clinical outcomes vs. PCI alone, Joo-Yong Hahn, MD, said here at TCT 2012.
“Several small clinical trials have shown that enzymatic infarct size was significantly reduced in [patients who underwent postconditioning] compared with a control group in patients undergoing primary PCI,” Hahn said during a presentation. However, he noted, studies using MRI to evaluate the effects of postconditioning on infarct size are inconsistent.
In a prospective, open-label, blinded-endpoint trial conducted at 17 centers in South Korea, Hahn, of Samsung Medical Center, Sungkyunkwan University School of Medicine in Seoul, and colleagues randomly assigned 700 patients (mean age, 60 years) with STEMI in a 1:1 fashion to primary PCI with or without postconditioning. Rate of complete ST-segment resolution >70% on ECG obtained 30 minutes after the procedure served as the primary endpoint.
Complete ST-segment resolution occurred in 40.5% and 41.5% of the postconditioning and conventional PCI groups, respectively (P=.79). According to baseline and follow-up data that were available for 97.5% of the 323 patients who completed four cycles of occlusion immediately after reflow, the rate of complete ST-segment resolution was 40.6%, which was similar to the conventional PCI group (P=.75). The researchers found no significant benefit of postconditioning across various subgroups.
Secondary outcomes also did not appear to differ between groups. The rate of post-procedural TIMI flow grade 3 tended to be higher in the postconditioning group vs. the PCI alone group, although this finding was not statistically significant (92% vs. 87.9%; P=.08). Additionally, post-procedural myocardial blush grade 0/1 did not differ significantly between treatment arms (17.2% vs. 22.4%; P=.2).
One-month clinical data were also similar for patients who underwent postconditioning and those who underwent PCI alone. Major adverse cardiac events — a composite of death, reinfarction, severe HF and stent thrombosis — occurred in 4.3% and 3.7% of the postconditioning and conventional PCI groups, respectively (P=.7).
The researchers found a significant association between ST-segment resolution, myocardial blush grade and post-procedural TIMI flow grade and clinical outcomes. Those with ST-segment resolution, for instance, had lower rates of death and major adverse cardiac events, whereas those with myocardial blush grades 0/1 had higher rates of major adverse cardiac events and death.
For more information:
Hahn JY. Plenary session XVII. First report investigations II. Presented at: TCT 2012; Oct. 22-26, 2012; Miami.
Disclosure: Hahn reports no relevant financial disclosures.