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Open Access Highly Accessed Research article

Long-term impact of postconditioning on infarct size and left ventricular ejection fraction in patients with ST-elevation myocardial infarction

Peder Sörensson13*, Lars Rydén1, Nawsad Saleh1, Per Tornvall1, Håkan Arheden2 and John Pernow1

Author Affiliations

1 Karolinska Institutet, Department of Medicine, Unit of Cardiology, Karolinska University Hospital, Stockholm, Sweden

2 Lund University, Department of Clinical Physiology, Skane University Hospital, Lund, Sweden

3 Department of Cardiology, Karolinska University Hospital, Stockholm, 171 76, Sweden

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BMC Cardiovascular Disorders 2013, 13:22  doi:10.1186/1471-2261-13-22

Published: 25 March 2013

Abstract

Background

Ischemic postconditioning (PostC), reperfusion in brief cycles, is known to induce short-term reduction in infarct size in patients with ST elevation myocardial infarction (STEMI), especially among those with large myocardium at risk (MaR). The aim of the present study was to investigate the long-term effect of PostC on infarct size and left ventricular ejection fraction (LVEF).

Methods

Sixty-eight patients with a first STEMI were randomised to primary percutaneous coronary intervention (PCI) (n = 35) or PCI followed by PostC (n = 33). MaR was determined as abnormally contracting segments on left ventricular angiogram. Cardiac magnetic resonance was performed at 3 and 12 months for the determination of infarct size and LVEF.

Results

Overall there was no difference in infarct size expressed in percentage of MaR between patients randomised to the control (31%; 23, 41) and PostC (31%; 23, 43) groups at 12 months. Likewise there was no difference in LVEF between control (49%; 41, 55) and PostC (52%; 45, 55). In contrast, patients in the PostC group with MaR in the upper quartile had a significantly smaller infarct size (29%; 18, 38) than those in the control group (40%; 34, 48; p < 0.05) at 12 months. In these patients LVEF was higher in the PostC (47%; 43, 50) compared to the control group (38%; 34, 42; p < 0.01).

Conclusions

In this long-term follow-up study PostC did not reduce infarct size in relation to MaR or improved LVEF in the overall study population. However, the present data suggest that PostC exerts long-term beneficial effects in patients with large MaR thereby extending previously published short-term observations.

Trial registration

Karolinska Clinical Trial Registration (http://www.kctr.se webcite). Unique identifier: CT20080014

Keywords:
Myocardial infarction; Infarct size; Postconditioning; CMR