Register
Forgot your password?

Results of implementation of ischemic postconditioningduring primary percutaneous coronary intervention in patientswith acute ST-segment elevation myocardial infarction

Authors: Harelikau A.V.1, Karpelev G.M.1, Cheherava T.I.2, Ostrovskiy Yu.P.3

Company: 1 Mogilev Regional Hospital, ulitsa Byalynitskogo-Biruli, 12, Mogilev, 212026, Republic of Belarus;
2 Mogilev State A. Kuleshov University, ulitsa Kosmonavtov, 1, Mogilev, 212022, Republic of Belarus;
3 Republican Scientific and Practical Centre “Cardiology”, ulitsa Rozy Lyuksemburg, 110B, Minsk, 220036, Republic of Belarus

For correspondence:  Sign in or register.

Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2019-13-2-114-128

For citation: Harelikau A.V., Karpelev G.M., Cheherava T.I., Ostrovskiy Yu.P. Results of implementation of ischemic postconditioning during primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction. Creative Cardiology. 2019; 13 (2): 114–28 (in Russ.). DOI: 10.24022/1997-3187-2019-13-2-114-128

Received / Accepted:  23.05.2019/29.05.2019

Keywords: acute ST-segment elevation myocardial infarction myocardial reperfusion injury ischemic postconditioning

Download
Full text:  

 

Abstract

Objective. To assess the effectiveness of ischemic postconditioning in patients with acute ST-segment elevation myocardial infarction (STEMI).

Material and methods. Results of treatment of 60 patients with STEMI, aged 32–65 years with complete occlusion of one of major coronary arteries, ST-segment elevation more than 0.1 mV in more than 2 contiguous leads and presentation within 6 hours after chest pain onset were analyzed. 31 patients were randomized to control, and 29 to postconditioning group. All patients underwent standard primary percutaneous coronary intervention. Within 1 minute after coronary blood flow restoration postconditioning group patients additionally underwent ischemic postconditioning procedure by a series of five consecutive short cycles of occlusion (60 s) / opening (30 s) of coronary artery.

Results. Final infarct size was smaller in postconditioning group (21.0±10.2% in control group, 6.3±7.3% in postconditioned group, p=0.0001) according to single photon emission computed tomography (SPECT) data. Myocardial infarction expansion was observed in 4 patients from control group. Myocardial injury biomarkers' activity was higher in control group: difference in area under the enzyme activity curve for creatine kinase (CK) was 80% (p=0.0025), for creatine kinase isoenzyme MB fraction (CK-МВ) 62% (p=0.015), for aspartate aminotransferase (AST) 57% (p=0.003), for lactate dehydrogenase (LDH) 82% (p=0.003) and for LDH-1, 2 – 99% (p=0.0009). Assessment of left ventricle contractile function by means of SPECT data showed ejection fraction of 39.4±8.2% in control group and of 48.4±6.3% in postconditioning group (p=0.0001), and by means of echocardiography 51.6±8.5% and 61.5±7.9%, respectively (p=0.0001).

Conclusion. Ischemic postconditioning in patients with STEMI effectively prevents reperfusion injury, contributes to decrease in final infarct size and leads to systolic left ventricle function improvements.

References

  1. Stone G.W., Selker H.P., Thiele H., Patel M.P., Udelson J.E., Ohman E.M. et al. Relationship between infarct size and outcomes following primary PCI: patient-level analysis from 10 randomized trials. J. Am. Coll. Cardiol. 2016; 67 (14): 1674–83. DOI: 10.1016/j.jacc.2016.01.069
  2. Keeley E.C., Boura J.A., Grines C.L. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet. 2003; 361: 13–20. DOI: 10.1016/S0140-6736(03)12113-7
  3. Yellon D.M., Hausenloy D.J. Myocardial reperfusion injury. N. Engl. J. Med. 2007; 357: 1121–35. DOI: 10.1056/NEJMra071667
  4. Fox K.A., Carruthers K.F., Dunbar D.R., Graham C., Manning J.R., DeRaedt H. Underestimated and under-recognized: The late consequences of acute coronary syndrome (GRACE UK-Belgian Study). Eur. Heart J. 2010; 31: 2755–64. DOI: 10.1093/eurheartj/ehq326
  5. Murry C.E., Jennings R.B., Reimer K.A. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation. 1986; 74: 1124–36.
  6. Heusch G. Critical issues for the translation of cardioprotection. Circ. Res. 2017; 120: 1477–86. DOI: 10.1161/CIRCRESAHA.117.310820
  7. Zhao Z.-Q., Corvera J.S., Halkos M.E., Kerendi F., Wang N.-P., Guyton R.A., Vinten-Johansen J. Inhibition of myocardial injury by ischemic postconditioning during reperfusion: comparison with ischemic preconditioning. Am. J. Physiol. 2003; 285 (2): H579–88. DOI: 10.1152/ajpheart.01064.2002
  8. Staat P., Rioufol G., Piot C., Cottin Y., Cung T.T., L'Huillier I. et al. Postconditioning the human heart. Circulation. 2005; 112: 2143–8. DOI: 10.1161/CIRCULATIONAHA.105.558122
  9. Shi W., Vinten-Johansen J. Endogenous cardioprotection by ischaemic postconditioning and remote conditioning. Cardiovasc. Res. 2012; 94: 206–16.
  10. Heusch G. Molecular basis of cardioprotection: signal transduction in ischemic pre-, post-, and remote conditioning. Circ. Res. 2015; 116 (4): 674–99. DOI: 10.1161/CIRCRESAHA.116.305348
  11. Hausenloy D.J., Botker H.E., Engstrom T., Erlinge D., Heusch G., Ibanez B. et al. Targeting reperfusion injury in patients with ST-segment elevation myocardial infarction: trials and tribulations. Eur. Heart J. 2017; 38 (13): 935–41. DOI: 10.1093/eurheartj/ehw145
  12. Blusztein D.I., Brooks M.J., Andrews D.T. A systematic review and meta-analysis evaluating ischemic conditioning during percutaneous coronary intervention. Fut. Cardiol. 2017; 13 (6): 579–92. DOI: 10.2217/fca-2017-0042
  13. Touboul C., Angoulvant D., Mewton N., Ivanes F., Muntean D., Prunier F. et al. Ischaemic postconditioning reduces infarct size: systematic review and meta-analysis of randomized controlled trials. Arch. Cardiovas. Dis. 2015; 108 (1): 39–49. DOI: 10.1016/j.acvd.2014.08.004
  14. Abdelnoor M., Sandven I., Limalanathan S., Eritsland J. Postconditioning in ST-elevation myocardial infarction: a systematic review, critical appraisal, and meta-analysis of randomized clinical trials. Vasc. Health Risk Manag. 2014; 10: 477–91. DOI: 10.2147/VHRM.S67154
  15. Traverse J., Swingen C., Henry T., Fox J., Wang Y., Chavez I.J. et al. NHLBI-sponsored randomized trial of postconditioning during primary percutaneous coronary intervention for ST-elevation myocardial infarction. Circ. Res. 2019; 124: 769–78. DOI: 10.1161/CIRCRESAHA.118.314060
  16. Lønborg J., Kelbaek H., Vejlstrup N., Jørgensen E., Helqvist S., Saunamäki K. et al. Cardioprotective effects of ischemic postconditioning in patients treated with primary percutaneous coronary intervention, evaluated by magnetic resonance. Circ. Cardiovasc. Interv. 2010; 3 (1): 34–41. DOI: 10.1161/CIRCINTERVENTIONS.109.905521
  17. Xue F., Yang X., Zhang B., Zhao C., Song J., Jiang T. et al. Postconditioning the human heart in percutaneous coronary intervention. Clin. Cardiol. 2010; 33 (7): 439–44. DOI: 10.1002/clc.20796
  18. Thibault H., Piot C., Staat P., Bontemps L., Sportouch C., Rioufol G. et al. Long-term benefit of postconditioning. Circulation. 2008; 117 (8): 1037–44. DOI: 10.1161/CIRCULATIONAHA.107.729780
  19. Sörensson P., Saleh N., Bouvier F., Böhm F., Settergren M., Caidahl K. et al. Effect of postconditioning on infarct size in patients with ST elevation myocardial infarction. Heart. 2010; 96 (21): 1710–5. DOI: 10.1136/hrt.2010.199430
  20. Freixa X., Bellera N., Ortiz-Pérez JT., Jiménez M., Paré C., Bosch X. et al. Ischaemic postconditioning revisited: Lack of effects on infarct size following primary percutaneous coronary intervention. Eur. Heart J. 2012; 33 (1): 103–12. DOI: 10.1093/eurheartj/ehr297
  21. Hahn J.Y., Song Y.B., Kim E.K., Yu C.W., Bae J.-W., Chung W.-Y. et al. Ischemic postconditioning during primary percutaneous coronary intervention: the effects of postconditioning on myocardial reperfusion in patients with ST-segment elevation myocardial infarction (POST) randomized trial. Circulation. 2013; 128: 1889–96. DOI: 10.1161/CIRCULATIONAHA.113.001690
  22. Limalanathan S., Andersen G., Kløw N.-E., Abdelnoor M., Hoffmann P., Eritsland J. Effect of ischemic postconditioning on infarct size in patients with ST-elevation myocardial infarction treated by primary PCI results of the POSTEMI (POstconditioning in ST-Elevation Myocardial Infarction) randomized trial. J. Am. Heart Assoc. 2014; 3 (2): e000679. DOI: 10.1161/JAHA.113.000679
  23. Engstrøm T., Kelbøk H., Helqvist S., Høfsten D.E., Kløvgaard L., Clemmensen P. et al. Effect of ischemic postconditioning during primary percutaneous coronary intervention for patients with STsegment elevation myocardial infarction: a randomized clinical trial. JAMA Cardiol. 2017; 2: 490–7. DOI: 10.1001/jamacardio.2017.0022
  24. Ferdinandy P., Hausenloy D.J., Heusch G., Baxter G.F., Schulz R. Interaction of risk factors, comorbidities, and comedications with ischemia/ reperfusion injury and cardioprotection by preconditioning, postconditioning, and remote conditioning. Pharmacol. Rev. 2014; 66: 1142–74. DOI: 10.1124/pr.113.008300
  25. Ma X., Zhang X., Li C., Luo M. Effect of postconditioning on coronary blood flow velocity and endothelial function in patients with acute myocardial infarction. Scand. Cardiovasc. J. 2006; 40 (6): 327–33. DOI: 10.1080/14017430601047864
  26.  Manchurov V.N., Ryazankina N.B., Reztsov R.Yu., Skrypnik D.V., Vasilieva E.Yu., Shpektor A.V. Effect of remote ischemic preconditioning and postconditioning on blood flow in the infarct-related artery and endothelial function in patients with ST-elevation myocardial infarction. Kardiologiia. 2016; 56 (1): 6–11 (in Russ.).
  27. Reffelmann T., Kloner R.A. The 'no-reflow' phenomenon: basic science and clinical correlates. Heart. 2002; 87: 162–8. DOI: 10.1136/heart.87.2.162
  28. Poli A., Fetiveau R., Vandoni P., del Rosso G., D'Urbano M., Seveso G., et al. Integrated analysis of myocardial blush and ST-segment elevation recovery after successful primary angioplasty. Realtime grading microvascular reperfusion and prediction of early and late recovery of left ventricular function. Circulation. 2002; 106 (3): 313–8.
  29. Van't Hof A.W.J., Liem A., Suryapranata H., Hoorntje J.C., de Boer M.J., Zijlstra F. Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction. Myocardial blush grade. Circulation. 1998; 97: 2302–6.
  30. Sorajja P., Gersh B.J., Costantini C., McLaughlin M.G., Zimetbaum P., Cox D.A. et al. Combined prognostic utility of ST-segment recovery and myocardial blush after primary percutaneous coronary intervention in acute myocardial infarction. Eur. Heart J. 2005; 26 (7): 667–74. DOI: 10.1093/eurheartj/ehi167
  31. Bekkers S.C., Yazdani S.K., Virmani R., Waltenberger J. Microvascular obstruction: underlying pathophysiology and clinical diagnosis. J. Am. Coll. Cardiol. 2010; 55 (16): 1649–60. DOI: 10.1016/j.jacc.2009.12.037
  32. Harelikau A. Ischemic postconditioning in prevention of myocardial reperfusion injury in patients with acute myocardial infarction and elevation of ST-segment. Cardiol. Belarus. 2017; 9 (1): 60–78.

About Authors

  • Andrei V. Harelikau, Postgraduate, Head of Department, Endovascular Surgeon, ORCID
  • Genadi M. Karpelev, Cand. Med. Sc., Head of Department, Radiologist;
  • Tat'ana I. Cheherava, Cand. Tech. Sc., Associate Professor;
  • Yuriy P. Ostrovskiy, Dr Med. Sc., Professor, Academician of the National Academy of Sciences of Belarus, Head of Laboratory, Cardiac Surgeon

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Sort by