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Mukherjee P, Jain M. Effect of ischemic postconditioning during primary percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction: A single-center cross-sectional study. Ann Card Anaesth 2020; 22:347-352. [PMID: 31621667 PMCID: PMC6813695 DOI: 10.4103/aca.aca_126_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Objective Reperfusion therapy for acute myocardial infarction has been shown to reduce mortality, yet it may also have deleterious effects, including myocardial necrosis and no-reflow. Postconditioning is known measure for cardioprotection from reperfusion injury in animal model. Postconditioning is known measure for cardioprotection from reperfusion injury in animal model and human studies have shown inconsistent results. Materials and Methods From February 2013 through October 2014, at Institute of Postgraduate Medical Education and Research, Kolkata Cardiology department, we randomized 43 patients with acute ST-segment elevation myocardial infarction (STEMI) who were undergoing conventional primary percutaneous coronary intervention (PCI) (22 patients) and PCI with postconditioning by repeated transient balloon occlusion after establishment of flow (21 patients). Total creatine kinase-muscle/brain (CPK-MB) released within 72 h was compared as a surrogate marker of infarct size. Myocardial blush grade between two groups was also compared. Results The area under curve of serum creatine kinase (CK) release during the 1st 72 h of reperfusion was significantly reduced (P = 0.0347) in the postconditioned group compared with the control group, averaging 9632 IU in postconditioned compared with 13493 IU in control group which represented 29% of reduction of infarct size. The peak of CPK-MB release was markedly lower in the postconditioned (290 ± 16.24 IU/L) than in the control (414.2 ± 51.34 IU/L) group (P ≤ 0.0001). Blush grading was also significantly improved in postconditioned group (P = 0.005). Mean ST-segment deviation at 48 h between cases and control groups was 0.87 ± 0.68 and 1.4 ± 0.94, respectively (P = 0.08). Conclusion In patients with STEMI, postconditioning significantly improves blush grading and enzymatic infarct size reduction with a trend toward significant reduction of mean ST-segment deviation.
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Affiliation(s)
- Priyam Mukherjee
- Department of Cardiology, Fortis Health Care, Kolkata, West Bengal, India
| | - Mayank Jain
- Choithram Hospital and Research Centre, Indore, Madhya Pradesh, India
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Lukovic D, Gugerell A, Zlabinger K, Winkler J, Pavo N, Baranyai T, Giricz Z, Varga ZV, Riesenhuber M, Spannbauer A, Traxler D, Jakab A, Garamvölgyi R, Petnehazy Ö, Pils D, Tóth L, Schulz R, Ferdinandy P, Gyöngyösi M. Transcriptional Alterations by Ischaemic Postconditioning in a Pig Infarction Model: Impact on Microvascular Protection. Int J Mol Sci 2019; 20:ijms20020344. [PMID: 30650650 PMCID: PMC6358966 DOI: 10.3390/ijms20020344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/04/2019] [Accepted: 01/08/2019] [Indexed: 11/16/2022] Open
Abstract
Although the application of cardioprotective ischaemia/reperfusion (I/R) stimuli after myocardial infarction (MI) is a promising concept for salvaging the myocardium, translation to a clinical scenario has not fulfilled expectations. We have previously shown that in pigs, ischaemic postconditioning (IPostC) reduces myocardial oedema and microvascular obstruction (MVO), without influencing myocardial infarct size. In the present study, we analyzed the mechanisms underlying the IPostC-induced microvascular protection by transcriptomic analysis, followed by pathway analysis. Closed-chest reperfused MI was induced by 90 min percutaneous balloon occlusion of the left anterior descending coronary artery, followed by balloon deflation in anaesthetised pigs. Animals were randomised to IPostC (n = 8), MI (non-conditioned, n = 8), or Control (sham-operated, n = 4) groups. After three hours or three days follow-up, myocardial tissue samples were harvested and subjected to RNA-seq analysis. Although the transcriptome analysis revealed similar expression between IPostC and MI in transcripts involved in cardioprotective pathways, we identified gene expression changes responding to IPostC at the three days follow-up. Focal adhesion signaling, downregulated genes participating in cardiomyopathy and activation of blood cells may have critical consequences for microvascular protection. Specific analyses of the gene subsets enriched in the endothelium of the infarcted area, revealed strong deregulation of transcriptional functional clusters, DNA processing, replication and repair, cell proliferation, and focal adhesion, suggesting sustentative function in the endothelial cell layer protection and integrity. The spatial and time-dependent transcriptome analysis of porcine myocardium supports a protective effect of IPostC on coronary microvasculature post-MI.
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Affiliation(s)
- Dominika Lukovic
- Department of Cardiology, Medical University of Vienna, A-1090 Vienna, Austria.
| | - Alfred Gugerell
- Department of Cardiology, Medical University of Vienna, A-1090 Vienna, Austria.
| | - Katrin Zlabinger
- Department of Cardiology, Medical University of Vienna, A-1090 Vienna, Austria.
| | - Johannes Winkler
- Department of Cardiology, Medical University of Vienna, A-1090 Vienna, Austria.
| | - Noemi Pavo
- Department of Cardiology, Medical University of Vienna, A-1090 Vienna, Austria.
| | - Tamás Baranyai
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, 1085 Budapest, Hungary.
| | - Zoltán Giricz
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, 1085 Budapest, Hungary.
| | - Zoltán V Varga
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, 1085 Budapest, Hungary.
| | - Martin Riesenhuber
- Department of Cardiology, Medical University of Vienna, A-1090 Vienna, Austria.
| | - Andreas Spannbauer
- Department of Cardiology, Medical University of Vienna, A-1090 Vienna, Austria.
| | - Denise Traxler
- Department of Cardiology, Medical University of Vienna, A-1090 Vienna, Austria.
| | - András Jakab
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, A-1090 Vienna, Austria.
- Center for MR-Research, University Children's Hospital, 8032 Zurich, Switzerland.
| | - Rita Garamvölgyi
- Institute of Diagnostic Imaging and Radiation Oncology, University of Kaposvár, 7400 Kaposvár, Hungary.
| | - Örs Petnehazy
- Institute of Diagnostic Imaging and Radiation Oncology, University of Kaposvár, 7400 Kaposvár, Hungary.
| | - Dietmar Pils
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, A-1090 Vienna, Austria.
| | - Levente Tóth
- Department of Radiology, University of Pécs, 7624 Pécs, Hungary.
| | - Rainer Schulz
- Institute of Physiology, Justus Liebig University Giessen, 35392 Giessen, Germany.
| | - Péter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, 1085 Budapest, Hungary.
- Pharmahungary Group, Graphisoft Park, 7 Záhony Street, H-1031 Budapest, Hungary.
| | - Mariann Gyöngyösi
- Department of Cardiology, Medical University of Vienna, A-1090 Vienna, Austria.
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Blusztein DI, Brooks MJ, Andrews DT. A systematic review and meta-analysis evaluating ischemic conditioning during percutaneous coronary intervention. Future Cardiol 2017; 13:579-592. [PMID: 29076346 DOI: 10.2217/fca-2017-0042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
AIM A systematic review and meta-analysis, evaluating ischemic conditioning during percutaneous coronary intervention (PCI). METHODS & RESULTS A database search of randomized trials of ischemic conditioning in PCI created three subgroups for meta-analysis: mortality in elective PCI with remote ischemic preconditioning (RIPreC; subgroup 1a, n = 3) - no outcome difference between RIPreC and control (odds ratio: 0.34; 95% CI: 0.08-1.56), myocardial salvage index in ST-elevation myocardial infarction (STEMI) with RIPreC (subgroup 1b, n = 2) - favored RIPreC (mean difference: 0.13; 95% CI: 0.07-0.19), and infarct size in STEMI with local ischemic postconditioning (LIPostC) (subgroup 4b, n = 12) - favored LIPostC (mean difference: -4.13 g.m-2; 95% CI: -7.36 to -0.90 g.m-2). CONCLUSION RIPreC and LIPostC improve myocardial salvage index and myocardial infarct size respectively in PCI for STEMI. No mortality benefit detected with RIPreC in elective PCI.
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Affiliation(s)
- David I Blusztein
- Cardiology Registrar, Department of Cardiology, The Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria 3050, Australia
| | - Matthew J Brooks
- Cardiologist, Department of Cardiology, The Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria 3050, Australia
| | - David T Andrews
- Honorary Clinical Associate Professor, Department of Anesthesia, Perioperative & Pain Medicine Unit, The University of Melbourne, Grattan St, Parkville, 3052, Australia.,Visiting Anesthetist, Department of Anesthesia & Pain Management, The Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria 3050, Australia
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Mechanical post-conditioning in STEMI patients undergoing primary percutaneous coronary intervention. J Saudi Heart Assoc 2015; 27:192-200. [PMID: 26136633 PMCID: PMC4481425 DOI: 10.1016/j.jsha.2014.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/05/2014] [Accepted: 11/11/2014] [Indexed: 11/21/2022] Open
Abstract
Although early myocardial reperfusion via primary percutaneous coronary intervention (PCI) allows the preservation of left ventricular function and improves outcome, the acute restoration of blood flow may contribute to the pathophysiology of infarction, a complex phenomenon called reperfusion injury. First described in animal models of coronary obstruction, mechanical post-conditioning, a sequence of repetitive interruption of coronary blood flow applied immediately after reopening of the occluded vessel, was able to reduce the infarct size. However, evidence of its real benefit remains controversial. This review describes the mechanisms of post-conditioning action and the different protocols employed focusing on its impact on primary PCI outcome.
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5
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Hu XQ, Cheng J, Tang B, Zhang ZH, Huang K, Yang YP, Mao YY, Zhong M, Fu SW. Clinical effect of postconditioning in ST-elevation myocardial infarction patients treated with primary percutaneous coronary intervention: a meta-analysis of randomized controlled trials. J Zhejiang Univ Sci B 2015; 16:198-207. [PMID: 25743121 PMCID: PMC4357369 DOI: 10.1631/jzus.b1400237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the clinical effect of postconditioning on patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). METHODS Randomized controlled trials were identified by searching relevant databases published up to April 2nd, 2014. A meta-analysis of eligible studies was performed by Stata 12.0 and Review Manager 5.2 with a fixed-effect model. RESULTS Ten studies providing adverse cardiac events in a total of 1346 STEMI patients treated with primary PCI were identified. The occurrence of heart failure was significantly reduced in patients treated with postconditioning compared with usual care (risk ratio (RR) 0.533; 95% confidence intervals (CI) 0.368-0.770), whereas non-fatal reinfarction slightly increased in the postconditioning group (RR 2.746; 95% CI 1.007-7.488). No significant difference in total major adverse cardiac events (MACEs) was observed between the two groups (RR 0.876; 95% CI 0.671-1.144). CONCLUSIONS Postconditioning in STEMI patients undergoing primary PCI significantly reduces the risk of heart failure, but fails to decrease the incidence of total MACEs and the risk of non-fatal reinfarction.
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Affiliation(s)
- Xian-qing Hu
- Department of Cardiovascular Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
| | - Jian Cheng
- Department of Cardiovascular Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
| | - Biao Tang
- Department of Cardiovascular Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
| | - Zhong-heng Zhang
- Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
| | - Ke Huang
- Department of Cardiovascular Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
| | - Yi-ping Yang
- Department of Cardiovascular Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
| | - Yan-yan Mao
- Department of Cardiovascular Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
| | - Ming Zhong
- Department of Cardiovascular Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
| | - Shen-wen Fu
- Department of Cardiovascular Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
- †E-mail:
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Khalili H, Patel VG, Mayo HG, de Lemos JA, Brilakis ES, Banerjee S, Bavry AA, Bhatt DL, Kumbhani DJ. Surrogate and clinical outcomes following ischemic postconditioning during primary percutaneous coronary intervention of ST--segment elevation myocardial infarction: a meta-analysis of 15 randomized trials. Catheter Cardiovasc Interv 2014; 84:978-86. [PMID: 24948465 DOI: 10.1002/ccd.25581] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/05/2014] [Accepted: 06/14/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To conduct a meta-analysis on surrogate and clinical outcomes with myocardial ischemic postconditioning (IPoC) following revascularization with primary percutaneous intervention (PPCI) for ST-segment myocardial infarction (STEMI) compared with PPCI alone. BACKGROUND Reperfusion injury remains an important problem following PPCI for STEMI. Trials of IPoC have mainly focused on cardiac biomarkers; the impact on clinical outcomes is unknown. METHODS Clinical trials that randomized STEMI patients to IPoC as compared with conventional PPCI were included for analysis. RESULTS A total of 15 randomized trials with 1,545 patients met our selection criteria (785 underwent IPoC + PPCI, 760 PPCI alone). Mean follow-up for clinical outcomes was 4.7 months. The mean ischemic time was 225 min. ST-segment resolution (Relative Risk [RR] = 0.98; 95% Confidence Intervals [CI] 0.85-1.13; P = 0.75) and infarct size (Weighted mean difference [WMD] = -2.53%, 95% CI -6.10 to 1.05; P = 0.17) were similar between the IPoC + PPCI vs. PPCI arms. Left ventricular ejection fraction at follow-up was marginally higher in the IPoC (WMD = 4.15%, 95% CI 0.19-8.12%, P = 0.04). No differences were noted in any of the clinical outcomes studied, including mortality (RR = 1.52; 95% CI 0.77-2.99; P = 0.23), recurrent MI (RR = 3.04; 95% CI 0.74-12.54; P = 0.12); stent thrombosis (RR = 1.24, 95% CI 0.51-3.04; P = 0.83) or the composite MACE outcome (RR = 1.53; 95% CI 0.89-2.63; P = 0.13). CONCLUSIONS IPoC following PPCI is not associated with improvements in surrogate or clinical outcomes at 5 months as compared with PPCI alone. Our findings indicate no role for IPoC in the routine management of patients with STEMI.
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Affiliation(s)
- Houman Khalili
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
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