Post-Conditioning Reduces Infarct Size and Edema in Patients With ST-Segment Elevation Myocardial Infarction

详细信息	查看全文 | 推荐本文 |

• 作者：Franck Thuny ; MD ; PhD^鈦?/sup> ; ^{franck.thuny@gmail.com} ; Olivier Lairez ; MD ; PhD^&dagger ; ; Franç ; ois Roubille ; MD ; PhD^&Dagger ; ; ^§ ; ; Nathan Mewton ; MD ; PhD^鈭?/sup> ; ^¶ ; ; Gilles Rioufol ; MD ; PhD^鈭?/sup> ; Catherine Sportouch ; MD^&dagger ; ; ^§ ; ; Ingrid Sanchez ; MD^鈦?/sup> ; ^¶ ; ; Cyrille Bergerot ; MD^¶ ; ; Hé ; lè ; ne Thibault ; MD ; PhD^鈦?/sup> ; ^鈭?/sup> ; Thien Tri Cung ; MD^&Dagger ; ; ^§ ; ; Gé ; rard Finet ; MD ; PhD^鈭?/sup> ; Laurent Argaud ; MD ; PhD^# ; Didier Revel ; MD ; PhD^鈦?/sup> ; Geneviè ; ve Derumeaux ; MD ; PhD^鈭?/sup> ; ^¶ ; ; Eric Bonnefoy-Cudraz ; MD ; PhD^¶ ; ; Meier Elbaz ; MD ; PhD^&dagger ; ; Christophe Piot ; MD ; PhD^&Dagger ; ; ^§ ; ; Michel Ovize ; MD ; PhD^鈭?/sup> ; ^¶ ; ; Pierre Croisille ; MD ; PhD^鈦?/sup> ; ^鈦庘亷
• 关键词：ischemia ; myocardial edema ; myocardial infarction ; post-conditioning ; reperfusion
• 刊名：Journal of the American College of Cardiology
• 出版年：2012
• 期刊代码：201_07351097
• 类别：med
• 出版时间：12 June, 2012
• 卷：59
• 期：24
• 页码：2175-2181
• 文件大小：607 K

摘要

| Figures/TablesFigures/Tables | ReferencesReferences

Objectives

This study aimed to determine whether post-conditioning at the time of percutaneous coronary intervention could reduce reperfusion-induced myocardial edema in patients with acute ST-segment elevation myocardial infarction (STEMI).

Background

Myocardial edema is a reperfusion injury with potentially severe consequences. Post-conditioning is a cardioprotective therapy that reduces infarct size after reperfusion, but no previous studies have analyzed the impact of this strategy on reperfusion-induced myocardial edema in humans.

Methods

Fifty patients with STEMI were randomly assigned to either a control or post-conditioned group. Cardiac magnetic resonance imaging was performed within 48 to 72 h after admission. Myocardial edema was measured by T2-weighted sequences, and infarct size was determined by late gadolinium enhancement sequences and creatine kinase release.

Results

The post-conditioned and control groups were similar with respect to ischemia time, the size of the area at risk, and the ejection fraction before percutaneous coronary intervention. As expected, post-conditioning was associated with smaller infarct size (13 卤 7 g/m² vs. 21 卤 14 g/m²; p = 0.01) and creatine kinase peak serum level (median [interquartile range]: 1,695 [1,118 to 3,692] IU/l vs. 3,505 [2,307 to 4,929] IU/l; p = 0.003). At reperfusion, the extent of myocardial edema was significantly reduced in the post-conditioned group as compared with the control group (23 卤 16 g/m² vs. 34 卤 18 g/m²; p = 0.03); the relative increase in T2W signal intensity was also significantly lower (p = 0.02). This protective effect was confirmed after adjustment for the size of the area at risk.

Conclusions

This randomized study demonstrated that post-conditioning reduced infarct size and edema in patients with reperfused STEMI. (Post Cond No Reflow; )