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DANAMI 3-iPost: Ischemic postconditioning shows no clinical benefit for patients with STEMI

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CHICAGO — Ischemic postconditioning failed to improve outcomes in patients with STEMI, according to research presented at the American College of Cardiology Scientific Session.

“Abrupt reperfusion by angioplasty may itself damage the heart muscle,” Thomas Engstrøm, MD, PhD, of Rigshospitalet University of Copenhagen, Denmark, said in a press release. “The thinking was that performing the reperfusion in a gentle, graded fashion would protect the heart against reperfusion injury.”

Engstrøm and colleagues enrolled 1,234 patients (mean age, 61; 79% men) with acute onset symptoms of 12 hours’ duration or less and ST-segment elevation .1 mV in at least two contiguous electrocardiographic leads or newly developed left bundle branch block who had TIMI 0-1 flow in the infarct-related artery and randomly assigned them to either receive standard angioplasty (n = 617) or ischemic postconditioning (n = 617) prior to stent implantation in the blocked artery. Median follow-up was 39 months.

Thomas Engstrøm

The primary endpoint was a composite of death from any cause and hospitalization for HF. Left ventricular ejection fraction was the secondary endpoint.

Sixty-five patients (10.5%) in the ischemic postconditioning group met the primary endpoint, compared with 69 (11.2%) in the standard care group (HR = 0.93, 95% CI, 0.66-1.3; P = .66). Mean LVEF was 52.7% in the postconditioning group vs. 50.8% in the standard care group. (P < .05).

Engstrøm said in a press conference that despite the results, their work is not finished yet.

“There may be a subset of patients that could benefit from post ischemic conditioning,” he said.

One limitation to the study, according Engstrøm, was that the physicians performing the angioplasties could not be blinded to the treatment group that patients were assigned to. by Tracey Romero

Reference:

Engstrøm T, et. al. Joint ACC/TCT Late-Breaking Clinical Trials. Presented at: American College of Cardiology Scientific Session; April 2-4, 2016; Chicago.

Disclosure: The study was funded by the Danish Agency for Science, Technology and Innovation and Danish Council for Strategic Research. Engstrøm reports no relevant financial disclosures.