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(Circulation. 2008;117:1037-1044.)
© 2008 American Heart Association, Inc.

Heart Failure

Long-Term Benefit of Postconditioning

Hélène Thibault, MD; Christophe Piot, MD, PhD; Patrick Staat, MD; Laurence Bontemps, MD; Catherine Sportouch, MD; Gilles Rioufol, MD, PhD; Thien Tri Cung, MD; Eric Bonnefoy, MD, PhD; Denis Angoulvant, MD; Jean-François Aupetit, MD, PhD; Gérard Finet, MD, PhD; Xavier André-Fouët, MD; Jean Christophe Macia, MD; Franck Raczka, MD; Rolland Rossi, MD; Rolland Itti, MD, PhD; Gilbert Kirkorian, MD, PhD; Geneviève Derumeaux, MD, PhD; Michel Ovize, MD, PhD

From the Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France (H.T., P.S., L.B., G.R., E.B., D.A., G.F., X.A.-F., R.R., R.I., G.K., G.D., M.O.); Hôpital Arnaud de Villeneuve, Montpellier, France (C.P., C.S., T.T.C., J.C.M., F.R.); Hôpital Saint Luc–Saint Joseph, Lyon, France (J.A.); and INSERM U886, Lyon, France (H.T., G.R., D.A., G.F., G.D., M.O.).

Correspondence to Professor Michel Ovize, Hôpital L. Pradel, Hospices Civils de Lyon, 59, Bd Pinel, 69394 Lyon Cedex 03, France. E-mail ovize{at}sante.univ-lyon1.fr

Received July 24, 2007; accepted December 24, 2007.

Background— We previously demonstrated that ischemic postconditioning decreases creatine kinase release, a surrogate marker for infarct size, in patients with acute myocardial infarction. Our objective was to determine whether ischemic postconditioning could afford (1) a persistent infarct size limitation and (2) an improved recovery of myocardial contractile function several months after infarction.

Methods and Results— Patients presenting within 6 hours of the onset of chest pain, with suspicion for a first ST-segment–elevation myocardial infarction, and for whom the clinical decision was made to treat with percutaneous coronary intervention, were eligible for enrollment. After reperfusion by direct stenting, 38 patients were randomly assigned to a control (no intervention; n=21) or postconditioned group (repeated inflation and deflation of the angioplasty balloon; n=17). Infarct size was assessed both by cardiac enzyme release during early reperfusion and by ²⁰¹thallium single photon emission computed tomography at 6 months after acute myocardial infarction. At 1 year, global and regional contractile function was evaluated by echocardiography. At 6 months after acute myocardial infarction, single photon emission computed tomography rest-redistribution index (a surrogate for infarct size) averaged 11.8±10.3% versus 19.5±13.3% in the postconditioned versus control group (P=0.04), in agreement with the significant reduction in creatine kinase and troponin I release observed in the postconditioned versus control group (–40% and –47%, respectively). At 1 year, the postconditioned group exhibited a 7% increase in left ventricular ejection fraction compared with control (P=0.04).

Conclusions— Postconditioning affords persistent infarct size reduction and improves long-term functional recovery in patients with acute myocardial infarction.

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CLINICAL PERSPECTIVE

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Clinical Summaries
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