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

作者：Thuny Franck^*; Lairez Olivier; Roubille Francois; Mewton Nathan; Rioufol Gilles; Sportouch Catherine; Sanchez Ingrid; Bergerot Cyrille; Thibault Helene; Cung Thien Tri; Finet Gerard; Argaud Laurent; Revel Didier; Derumeaux Genevieve; Bonnefoy Cudraz Eric; Elbaz Meier; Piot Christophe; Ovize Michel; Croisille Pierre

来源：Journal of the American College of Cardiology, 2012, 59(24): 2175-2181.

DOI：10.1016/j.jacc.2012.03.026

• ischemia
• myocardial edema
• myocardial infarction
• post-conditioning
• reperfusion

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). %26lt;br%26gt;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. %26lt;br%26gt;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. %26lt;br%26gt;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 +/- 7 g/m(2) vs. 21 +/- 14 g/m(2); 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 +/- 16 g/m(2) vs. 34 +/- 18 g/m(2); 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. %26lt;br%26gt;Conclusions This randomized study demonstrated that post-conditioning reduced infarct size and edema in patients with reperfused STEMI.

• 出版日期2012-6-12