Long-term effects of ischemic postconditioning on clinical outcomes: 1-year follow-up of the POST randomized trial

Joo Yong Hahn, Cheol Woong Yu, Hun Sik Park, Young Bin Song, Eun Kyoung Kim, Hyun Jong Lee, Jang Whan Bae, Woo Young Chung, Seung Hyuk Choi, Jin Ho Choi, Jang Ho Bae, Kyung Joo An, Jong Seon Park, Ju Hyeon Oh, Sang Wook Kim, Jin Yong Hwang, Jae Kean Ryu, Do Sun Lim, Hyeon Cheol Gwon

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Abstract

Background In the Effects of Postconditioning on Myocardial Reperfusion in Patients with ST-segment Elevation Myocardial Infarction (POST) trial, ischemic postconditioning failed to improve myocardial reperfusion. However, long-term effects of ischemic postconditioning on clinical outcomes are not known in patients with ST-segment elevation myocardial infarction. Methods A total of 700 patients undergoing primary percutaneous coronary intervention (PCI) were randomly assigned to the postconditioning group or the conventional primary PCI group in a 1:1 ratio. Postconditioning was performed immediately after restoration of coronary flow by balloon occlusion 4 times for 1 minute. Complete follow-up data for major clinical events at 1 year were available in 695 patients (99.3%), and analyses were done by the intention to treat principle. The primary outcome was a composite of death, myocardial infarction, severe heart failure, or stent thrombosis at 1 year. Results At 1 year, a composite of death, myocardial infarction, severe heart failure, or stent thrombosis occurred in 21 patients (6.1%) in the postconditioning group and 16 patients (4.6%) in the conventional PCI group (hazard ratio [HR] 1.32, 95% CI 0.69-2.53, P =.40). The risk of death (4.9% vs 3.7%, HR 1.32, 95% CI 0.64-2.71, P =.46), heart failure (2.6% vs 2.3%, HR 1.13, 95% CI 0.44-2.94, P =.80), and stent thrombosis (2.3% vs 1.7%, HR 1.34, 95% CI 0.46-3.85, P =.59) did not differ significantly between the 2 groups. Conclusions Ischemic postconditioning does not seem to improve the 1-year clinical outcomes in patients with ST-segment elevation myocardial infarction undergoing primary PCI.

Original languageEnglish
Pages (from-to)639-646
Number of pages8
JournalAmerican Heart Journal
Volume169
Issue number5
DOIs
StatePublished - 1 May 2015

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Hahn, J. Y., Yu, C. W., Park, H. S., Song, Y. B., Kim, E. K., Lee, H. J., Bae, J. W., Chung, W. Y., Choi, S. H., Choi, J. H., Bae, J. H., An, K. J., Park, J. S., Oh, J. H., Kim, S. W., Hwang, J. Y., Ryu, J. K., Lim, D. S., & Gwon, H. C. (2015). Long-term effects of ischemic postconditioning on clinical outcomes: 1-year follow-up of the POST randomized trial. American Heart Journal, 169(5), 639-646. https://doi.org/10.1016/j.ahj.2015.01.015