Author + information
- Aleksander Araszkiewicz1,
- Marek Grygier2,
- Malgorzata Pyda3,
- Justyna Rajewska-Tabor2,
- Maciej Lesiak1 and
- Stefan Grajek4
Postconditiong (postcon) has been reported to reduce infarct size in ST-segment myocardial infarction (STEMI). However recently few other studies did not show any effect of postcon or suggested that it may be even harmful. We sought to assess whether postcon could reduce infarct size (IS) and microvascular obstruction (MVO) zone in early presenters with high-risk STEMI.
74 STEMI patients treated with primary coronary intervention (PCI) were randomly assigned to postcon group (n=37) or standard PCI group (n=37). Postcon was performed immediately after obtained reperfusion with 4 balloon occlusions, each lasting 30 seconds, followed by 30 seconds of reperfusion. Cardiac magnetic resonance was performed in all subjects within 48 to 96 hours after the admission. Morphology and function of myocardium was estimated by a steady-state free precession (SSFP) sequence. To evaluate the infarct size and MVO, a late gadolinium enhancement (LGE) technique was performed.Infarct size was defined as an area greater than 50% of the maximal signal intensity within LGE. MVO was defined as an area of the absence or hypoenhancement of contrast surrounded by LGE. Infarct size and MVO were determined by planimetry and a summation of discs method.
Postcon was associated with significantly smaller IS (16.58±9.6 vs 31.2±22.9 g; p=0.007) and higher ejection fraction (59.8±9.2% vs 52.3±10.2%) as well as in lower creatinine kinase and troponin I peak serum level (2297±1391 vs 3268±1163; p<0.001 and 47.4± 57.1 vs 136±122; p<0.01, respectively). The extent of MVO was significantly lower in postcon group in comparison to control group (0.71± 1.4g vs 2.2±3.2g; p=0.03).
In early presenters with STEMI postcon could significantly reduce infarct size and limit reperfusion injury.
IMAGING: Imaging: Non-Invasive