This article is more than 5 years old. Information may no longer be current.
Procedure may reduce enzymatic infarct size in anterior STEMI
Click Here to Manage Email Alerts
Remote ischemic post-conditioning during primary PCI reduced enzymatic infarct size and was associated with a reduction of T2-weighted edema volume and an improvement of ST-segment resolution in patients who underwent stenting within 6 hours of symptom onset.
Researchers of the study randomly assigned 96 patients with anterior STEMI and an occluded left anterior descending artery to primary PCI plus remote ischemic post-conditioning or to a control group of conventional PCI. The intervention consisted of three cycles of 5’/5’ ischemia/reperfusion of the lower limb by cuff inflation/deflation.
Median area under the curve of creatinine kinase-MB was 8,814 arbitrary units (interquartile range [IQR], 5,567-11,325) in the intervention group and 10,065 arbitrary units (IQR, 7,465-14,004) in controls (relative reduction, 20%; 95% CI, 0.2-28.7).
As part of the study, 77 patients underwent a cardiac magnetic resonance scan 3 to 5 days after randomization and 66 patients repeated a second scan after 4 months. T2-weighted edema volume was 37 ± 16 cc in intervention patients and 47 ± 22 cc in controls (P=.049). ST-segment resolution >50% was 66% in intervention group and 37% in controls (P=.015). There was a numerical, although not statistically significant, improvement in TIMI frame count, myocardial blush grading and delayed enhancement volume.
“The benefit observed, though smaller than expected and marginally significant, was directionally consistent with markers of myocardial reperfusion injury and successful reperfusion such as a reduction of T2-weighted edema volume and an improvement in [ST-segment resolution],” the researchers wrote. “Notably these effects were observed in addition to those provided by optimal thrombus management including thrombectomy and use of anti-[glycoprotein] IIb/IIIa.”
According to Gabriele Crimi, MD, one of the study researchers with SC Cardiologia, ASL3 Ospedale Villa Scassi, Genoa, Italy, the results shows for the first time that remote ischemic post-conditioning of the lower limb at the time of primary PCI reduces the primary endpoint of enzymatic infarct size on top of the optimal thrombus management (manual thrombectomy plus glycoprotein IIb/IIIa inhibitors).
“The result of the secondary endpoint supports the hypothesis that the effects of remote post-conditioning are mediated by the mitigating myocardial reperfusion injury,” he told Cardiology Today’s Intervention. “This promising, very safe intervention warrants further investigation.”
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts