No benefit of ischemic postconditioning during PCI
medwireNews: Results of the DANAMI-3–iPOST trial suggest that ischemic postconditioning during percutaneous coronary intervention (PCI) does not improve clinical outcome for patients with ST-segment elevation myocardial infarction (STEMI).
Thomas Engstrøm (University of Copenhagen, Denmark) and co-investigators found that 10.5% of 617 participants who underwent ischemic postconditioning died or were hospitalized for heart failure over a median follow-up of 38 months, compared with 11.2% of 617 patients who underwent conventional PCI, a nonsignificant difference.
As reported in JAMA Cardiology, participants of DANAMI-3–iPOST (The Third Danish Study of Optimal Acute Treatment of Patients With ST Elevation Myocardial Infarction–Ischemic Postconditioning) were randomly assigned to receive either postconditioning performed as four repeated 30-second balloon occlusions followed by 30 seconds of reperfusion immediately after opening of the culprit vessel and before stent implantation, or standard primary PCI.
There was no significant difference in the occurrence of cardiovascular death, recurrent MI, or target vessel revascularization by PCI between patients in the ischemic postconditioning and conventional PCI groups, with rates of 4.2% versus 4.9%, 5.3% versus 4.7%, and 3.1% versus 2.3%, respectively.
Furthermore, ischemic postconditioning did not reduce infarct size or the extent of microvascular obstruction, or increase myocardial salvage index, relative to standard PCI at 3 months. Resolution of ST-segment elevation was also similar in the two treatment groups.
The lack of effect of ischemic postconditioning on these “well-established prognostic predictors” supports “[t]he neutral result of our primary end point,” observe Engstrøm and team.
The authors note that the primary outcome of their trial was changed from a composite of cardiac death, reinfarction, and heart failure to a composite of all-cause death and hospitalization for heart failure after inclusion of the last patient due to difficulties in separating cardiac death from cardiovascular death.
However, they specify that “the adjustment was made before closing the database and before any knowledge or analysis of the data.”
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