JAY H. Traverse, MD, FACC, FAHA Director of Research, Minneapolis Heart Institute Foundation Associate Professor of Medicine, Cardiovascular Division University of Minnesota School of Medicine

Value of Postconditioning after Heart Attack May Be Seen only on Long Term Followup

MedicalResearch.com Interview with:

JAY H. Traverse, MD, FACC, FAHA Director of Research, Minneapolis Heart Institute Foundation Associate Professor of Medicine, Cardiovascular Division University of Minnesota School of Medicine

Dr. Traverse

JAY H. Traverse, MD, FACC, FAHA
Director of Research
Minneapolis Heart Institute Foundation
Associate Professor of Medicine
Cardiovascular Division
University of Minnesota School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Reperfusion injury may contribute a significant amount to final infarct size in setting of ST-elevation myocardial infarction (STEMI).

Several studies from Europe and Asia have suggested that modifying reperfusion with an angioplasty balloon of an occluded artery called postconditioning can reduce infarct size. However, not all studies show a benefit.

We hypothesized that patient selection of STEMI patients could contribute to these inconsistent findings so we performed the first postconditioning study in the US sponsored by the NIH using the strictest enrollment criteria of any study to minimize factors that influence infarct size (ischemic time, collaterals, pre-infarction angina, TIMI 0 flow) designed to maximize the benefit of postconditioning to see if it can actually reduce infarct size.

MedicalResearch.com: What should readers take away from your report?

Response: We did not show a benefit of postconditioning on infarct size or myocardial salvage when measured 2 days after STEMI by cardiac MRI. However, patients randomized to postconditioning has less microvascular obstruction (MVO) in the infarct zone compared to control that may have contributed to our observation of improved LV remodeling in the postconditioning group. In the 40% of subjects who did have MVO, those randomized to postconditioning had greater recovery of LV function and less adverse remodeling. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: The benefits of postconditioning may not be seen early on but only in long-term follow-up. Thus, long-term imaging and clinical follow-up is important in these patients. The improved remodeling at one year could translate to less development of heart failure over time with postconditioning

Disclosure: Funding from NHLBI 

Citation:

NHLBI-Sponsored Randomized Trial of Postconditioning During Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction

Jay H Traverse, Cory Swingen, Timothy D Henry, Jane Fox, Yale Wang,
Ivan Joel Chavez, Daniel L Lips, John R Lesser,Wes R Pedersen
,Nicholas M Burke, Akila Pai, Jana L Lindberg, and Ross Garberich
3 Jan 2019
https://doi.org/10.1161/CIRCRESAHA.118.314060
Circulation Research. 2019;0

Jan 16, 2019 @ 1:09 pm

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