Post-Conditioning Reduces Infarct Size and Edema in Patients With ST-Segment Elevation Myocardial Infarction

被引：224

作者：

Thuny, Franck ^{[1
]}

Lairez, Olivier ^{[2
]}

Roubille, Francois ^{[3
,4
]}

Mewton, Nathan ^{[5
,6
,7
]}

Rioufol, Gilles ^{[5
,6
]}

Sportouch, Catherine ^{[2
,4
]}

Sanchez, Ingrid ^{[1
,7
]}

Bergerot, Cyrille ^{[7
]}

Thibault, Helene ^{[1
,5
,6
]}

Cung, Thien Tri ^{[3
,4
]}

Finet, Gerard ^{[5
,6
]}

Argaud, Laurent ^{[9
]}

Revel, Didier ^{[1
]}

Derumeaux, Genevieve ^{[5
,6
,7
]}

Bonnefoy-Cudraz, Eric ^{[7
]}

Elbaz, Meier ^{[2
]}

Piot, Christophe ^{[3
,4
]}

Ovize, Michel ^{[5
,6
,7
]}

Croisille, Pierre ^{[1
,8
]}

机构：

[1] Univ Lyon, CREATIS, CNRS UMR 5220, INSERM U1044, Lyon, France

[2] Univ Toulouse 3, Hop Rangueil, Serv Cardiol, F-31062 Toulouse, France

[3] INSERM, U661, Montpellier, France

[4] Univ Montpellier I & II, Hop Arnaud de Villeneuve, Montpellier, France

[5] Cardioprotect Team, CARMEN, INSERM, U1060, Lyon, France

[6] CIC Lyon, Lyon, France

[7] Hosp Civils Lyon, Serv Explorat Fonct Cardiovasc, Lyon, France

[8] Univ St Etienne, Ctr Hosp Univ St Etienne, Serv Radiol, St Etienne, France

[9] Hosp Civils Lyon, Serv Reanimat Med, Lyon, France

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2012年 / 59卷 / 24期

关键词：

ischemia; myocardial edema; myocardial infarction; post-conditioning; reperfusion; CARDIOVASCULAR MAGNETIC-RESONANCE; CORONARY-ARTERY OCCLUSION; REPERFUSION INJURY; RISK; DETERMINANTS; ISCHEMIA; RECOVERY; HEART; AREA;

D O I：

10.1016/j.jacc.2012.03.026

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

Objectives This study aimed to determine whether post-conditioning at the time of percutaneous coronary intervention could reduce reperfusion-induced myocardial edema in patients with acute ST-segment elevation myocardial infarction (STEMI). Background Myocardial edema is a reperfusion injury with potentially severe consequences. Post-conditioning is a cardioprotective therapy that reduces infarct size after reperfusion, but no previous studies have analyzed the impact of this strategy on reperfusion-induced myocardial edema in humans. Methods Fifty patients with STEMI were randomly assigned to either a control or post-conditioned group. Cardiac magnetic resonance imaging was performed within 48 to 72 h after admission. Myocardial edema was measured by T2-weighted sequences, and infarct size was determined by late gadolinium enhancement sequences and creatine kinase release. Results The post-conditioned and control groups were similar with respect to ischemia time, the size of the area at risk, and the ejection fraction before percutaneous coronary intervention. As expected, post-conditioning was associated with smaller infarct size (13 +/- 7 g/m(2) vs. 21 +/- 14 g/m(2); p = 0.01) and creatine kinase peak serum level (median [interquartile range]: 1,695 [1,118 to 3,692] IU/l vs. 3,505 [2,307 to 4,929] IU/l; p = 0.003). At reperfusion, the extent of myocardial edema was significantly reduced in the post-conditioned group as compared with the control group (23 +/- 16 g/m(2) vs. 34 +/- 18 g/m(2); p = 0.03); the relative increase in T2W signal intensity was also significantly lower (p = 0.02). This protective effect was confirmed after adjustment for the size of the area at risk. Conclusions This randomized study demonstrated that post-conditioning reduced infarct size and edema in patients with reperfused STEMI. (Post Cond No Reflow; NCT01208727) (J Am Coll Cardiol 2012;59:2175-81) (C) 2012 by the American College of Cardiology Foundation

引用

页码：2175 / 2181

页数：7

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