Effect of Ischemic Postconditioning During Primary Percutaneous Coronary Intervention for Patients With ST-Segment Elevation Myocardial Infarction: A Randomized Clinical Trial.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Engstrøm Thomas, Kelbæk Henning, Helqvist Steffen, Høfsten Dan Eik, Kløvgaard Lene, Clemmensen Peter, Holmvang Lene, Jørgensen Erik, Pedersen Frants, Saunamaki Kari, Ravkilde Jan, Tilsted Hans-Henrik, Villadsen Anton, Aarøe Jens, Jensen Svend Eggert, Raungaard Bent, Bøtker Hans E, Terkelsen Christian J, Maeng Michael, Kaltoft Anne, Krusell Lars R, Jensen Lisette O, Veien Karsten T, Kofoed Klaus Fuglsang, Torp-Pedersen Christian, Kyhl Kasper, Nepper-Christensen Lars, Treiman Marek, Vejlstrup Niels, Ahtarovski Kiril, Lønborg Jacob, Køber Lars, Third Danish Study of Optimal Acute Treatment of Patients With ST Elevation Myocardial Infarction–Ischemic Postconditioning (DANAMI-3–iPOST) Investigators
Аннотация
OBJECTIVE: To determine whether ischemic postconditioning can improve the clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI).
DESIGN, SETTING, AND PARTICIPANTS: In this multicenter, randomized clinical trial, patients with onset of symptoms within 12 hours, STEMI, and thrombolysis in myocardial infarction (TIMI) grade 0-1 flow in the infarct-related artery at arrival were randomized to conventional PCI or postconditioning. Inclusion began on March 21, 2011, through February 2, 2014, and follow-up was completed on February 2, 2016. Analysis was based on intention to treat.
INTERVENTIONS: Patients were randomly allocated 1:1 to conventional primary PCI, including stent implantation, or postconditioning performed as 4 repeated 30-second balloon occlusions followed by 30 seconds of reperfusion immediately after opening of the infarct-related artery and before stent implantation.
MAIN OUTCOME AND MEASURES: A combination of all-cause death and hospitalization for heart failure.
RESULTS: During the inclusion period, 1234 patients (975 men [79.0%] and 259 women [21.0%]; mean [SD] age, 62 [11] years) underwent randomization in the trial. Median follow-up was 38 months (interquartile range, 24-58 months). The primary outcome occurred in 69 patients (11.2%) who underwent conventional primary PCI and in 65 (10.5%) who underwent postconditioning (hazard ratio, 0.93; 95% CI, 0.66-1.30; P = .66). The hazard ratios were 0.75 (95% CI, 0.49-1.14; P = .18) for all-cause death and 0.99 (95% CI, 0.60-1.64; P = .96) for heart failure.
CONCLUSIONS AND RELEVANCE: Routine ischemic postconditioning during primary PCI failed to reduce the composite outcome of death from any cause and hospitalization for heart failure in patients with STEMI and TIMI grade 0-1 flow at arrival.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01435408.