Effect of ischemic postconditioning during primary percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction: A randomized clinical trial

Thomas Engstrøm; Henning Kelbæk; Steffen Helqvist; Dan Eik Høfsten; Lene Kløvgaard; Peter Clemmensen; Lene Holmvang; Erik Jørgensen; Frants Pedersen; Kari Saunamaki; Jan Ravkilde; Hans Henrik Tilsted; Anton Villadsen; Jens Aarøe; Svend Eggert Jensen; Bent Raungaard; Hans E. Bøtker; Christian J. Terkelsen; Michael Maeng; Anne Kaltoft; Lars R. Krusell; Lisette O. Jensen; Karsten T. Veien; Klaus Fuglsang Kofoed; Christian Torp-Pedersen; Kasper Kyhl; Lars Nepper-Christensen; Marek Treiman; Niels Vejlstrup; Kiril Ahtarovski; Jacob Lønborg; Lars Køber; Third Danish Study of Optimal Acute Treatment of Patients With ST Elevation Myocardial Infarction-Ischemic Postconditioning (DANAMI-3-iPOST) Investigators

doi:10.1001/jamacardio.2017.0022

Effect of ischemic postconditioning during primary percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction: A randomized clinical trial

Thomas Engstrøm^*, Henning Kelbæk, Steffen Helqvist, Dan Eik Høfsten, Lene Kløvgaard, Peter Clemmensen, Lene Holmvang, Erik Jørgensen, Frants Pedersen, Kari Saunamaki, Jan Ravkilde, Hans Henrik Tilsted, Anton Villadsen, Jens Aarøe, Svend Eggert Jensen, Bent Raungaard, Hans E. Bøtker, Christian J. Terkelsen, Michael Maeng, Anne KaltoftLars R. Krusell, Lisette O. Jensen, Karsten T. Veien, Klaus Fuglsang Kofoed, Christian Torp-Pedersen, Kasper Kyhl, Lars Nepper-Christensen, Marek Treiman, Niels Vejlstrup, Kiril Ahtarovski, Jacob Lønborg, Lars Køber, Third Danish Study of Optimal Acute Treatment of Patients With ST Elevation Myocardial Infarction-Ischemic Postconditioning (DANAMI-3-iPOST) Investigators

^*Corresponding author for this work

68 Citations (Scopus)

Abstract

Importance: Ischemic postconditioning of the heart during primary percutaneous coronary intervention (PCI) induced by repetitive interruptions of blood flow to the ischemic myocardial region immediately after reopening of the infarct-related arterymay limit myocardial damage. Objective: To determine whether ischemic postconditioning can improve the clinical outcomes in patients with ST-segment elevationmyocardial infarction (STEMI). Design, Setting, and Participants: In this multicenter, randomized clinical trial, patients with onset of symptoms within 12 hours, STEMI, and thrombolysis inmyocardial 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.

Original language	English
Journal	JAMA Cardiology
Volume	2
Issue number	5
Pages (from-to)	490-497
Number of pages	8
ISSN	2380-6583
DOIs	https://doi.org/10.1001/jamacardio.2017.0022
Publication status	Published - May 2017

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Engstrøm, T., Kelbæk, H., Helqvist, S., Høfsten, D. E., Kløvgaard, L., Clemmensen, P., Holmvang, L., Jørgensen, E., Pedersen, F., Saunamaki, K., Ravkilde, J., Tilsted, H. H., Villadsen, A., Aarøe, J., Jensen, S. E., Raungaard, B., Bøtker, H. E., Terkelsen, C. J., Maeng, M., ... Third Danish Study of Optimal Acute Treatment of Patients With ST Elevation Myocardial Infarction-Ischemic Postconditioning (DANAMI-3-iPOST) Investigators (2017). Effect of ischemic postconditioning during primary percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction: A randomized clinical trial. JAMA Cardiology, 2(5), 490-497. https://doi.org/10.1001/jamacardio.2017.0022

Effect of ischemic postconditioning during primary percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction: A randomized clinical trial. / Engstrøm, Thomas; Kelbæk, Henning; Helqvist, Steffen et al.
In: JAMA Cardiology, Vol. 2, No. 5, 05.2017, p. 490-497.

Research output: Contribution to journal › Journal article › Research › peer-review

Engstrøm, T, Kelbæk, H, Helqvist, S, Høfsten, DE, Kløvgaard, L, Clemmensen, P, Holmvang, L, Jørgensen, E, Pedersen, F, Saunamaki, K, Ravkilde, J, Tilsted, HH, Villadsen, A, Aarøe, J, Jensen, SE, Raungaard, B, Bøtker, HE, Terkelsen, CJ, Maeng, M, Kaltoft, A, Krusell, LR, Jensen, LO, Veien, KT, Kofoed, KF, Torp-Pedersen, C, Kyhl, K, Nepper-Christensen, L, Treiman, M, Vejlstrup, N, Ahtarovski, K, Lønborg, J, Køber, L & Third Danish Study of Optimal Acute Treatment of Patients With ST Elevation Myocardial Infarction-Ischemic Postconditioning (DANAMI-3-iPOST) Investigators 2017, 'Effect of ischemic postconditioning during primary percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction: A randomized clinical trial', JAMA Cardiology, vol. 2, no. 5, pp. 490-497. https://doi.org/10.1001/jamacardio.2017.0022

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title = "Effect of ischemic postconditioning during primary percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction: A randomized clinical trial",

abstract = "Importance: Ischemic postconditioning of the heart during primary percutaneous coronary intervention (PCI) induced by repetitive interruptions of blood flow to the ischemic myocardial region immediately after reopening of the infarct-related arterymay limit myocardial damage. Objective: To determine whether ischemic postconditioning can improve the clinical outcomes in patients with ST-segment elevationmyocardial infarction (STEMI). Design, Setting, and Participants: In this multicenter, randomized clinical trial, patients with onset of symptoms within 12 hours, STEMI, and thrombolysis inmyocardial 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.",

author = "Thomas Engstr{\o}m and Henning Kelb{\ae}k and Steffen Helqvist and H{\o}fsten, {Dan Eik} and Lene Kl{\o}vgaard and Peter Clemmensen and Lene Holmvang and Erik J{\o}rgensen and Frants Pedersen and Kari Saunamaki and Jan Ravkilde and Tilsted, {Hans Henrik} and Anton Villadsen and Jens Aar{\o}e and Jensen, {Svend Eggert} and Bent Raungaard and B{\o}tker, {Hans E.} and Terkelsen, {Christian J.} and Michael Maeng and Anne Kaltoft and Krusell, {Lars R.} and Jensen, {Lisette O.} and Veien, {Karsten T.} and Kofoed, {Klaus Fuglsang} and Christian Torp-Pedersen and Kasper Kyhl and Lars Nepper-Christensen and Marek Treiman and Niels Vejlstrup and Kiril Ahtarovski and Jacob L{\o}nborg and Lars K{\o}ber and {Third Danish Study of Optimal Acute Treatment of Patients With ST Elevation Myocardial Infarction-Ischemic Postconditioning (DANAMI-3-iPOST) Investigators}",

year = "2017",

month = may,

doi = "10.1001/jamacardio.2017.0022",

language = "English",

volume = "2",

pages = "490--497",

journal = "JAMA Cardiology",

issn = "2380-6583",

publisher = "American Medical Association",

number = "5",

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TY - JOUR

T1 - Effect of ischemic postconditioning during primary percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction

T2 - A randomized clinical trial

AU - Engstrøm, Thomas

AU - Kelbæk, Henning

AU - Helqvist, Steffen

AU - Høfsten, Dan Eik

AU - Kløvgaard, Lene

AU - Clemmensen, Peter

AU - Holmvang, Lene

AU - Jørgensen, Erik

AU - Pedersen, Frants

AU - Saunamaki, Kari

AU - Ravkilde, Jan

AU - Tilsted, Hans Henrik

AU - Villadsen, Anton

AU - Aarøe, Jens

AU - Jensen, Svend Eggert

AU - Raungaard, Bent

AU - Bøtker, Hans E.

AU - Terkelsen, Christian J.

AU - Maeng, Michael

AU - Kaltoft, Anne

AU - Krusell, Lars R.

AU - Jensen, Lisette O.

AU - Veien, Karsten T.

AU - Kofoed, Klaus Fuglsang

AU - Torp-Pedersen, Christian

AU - Kyhl, Kasper

AU - Nepper-Christensen, Lars

AU - Treiman, Marek

AU - Vejlstrup, Niels

AU - Ahtarovski, Kiril

AU - Lønborg, Jacob

AU - Køber, Lars

AU - Third Danish Study of Optimal Acute Treatment of Patients With ST Elevation Myocardial Infarction-Ischemic Postconditioning (DANAMI-3-iPOST) Investigators

PY - 2017/5

Y1 - 2017/5

N2 - Importance: Ischemic postconditioning of the heart during primary percutaneous coronary intervention (PCI) induced by repetitive interruptions of blood flow to the ischemic myocardial region immediately after reopening of the infarct-related arterymay limit myocardial damage. Objective: To determine whether ischemic postconditioning can improve the clinical outcomes in patients with ST-segment elevationmyocardial infarction (STEMI). Design, Setting, and Participants: In this multicenter, randomized clinical trial, patients with onset of symptoms within 12 hours, STEMI, and thrombolysis inmyocardial 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.

AB - Importance: Ischemic postconditioning of the heart during primary percutaneous coronary intervention (PCI) induced by repetitive interruptions of blood flow to the ischemic myocardial region immediately after reopening of the infarct-related arterymay limit myocardial damage. Objective: To determine whether ischemic postconditioning can improve the clinical outcomes in patients with ST-segment elevationmyocardial infarction (STEMI). Design, Setting, and Participants: In this multicenter, randomized clinical trial, patients with onset of symptoms within 12 hours, STEMI, and thrombolysis inmyocardial 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.

U2 - 10.1001/jamacardio.2017.0022

DO - 10.1001/jamacardio.2017.0022

M3 - Journal article

C2 - 28249094

AN - SCOPUS:85026826837

SN - 2380-6583

VL - 2

SP - 490

EP - 497

JO - JAMA Cardiology

JF - JAMA Cardiology

IS - 5

ER -

Effect of ischemic postconditioning during primary percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction: A randomized clinical trial

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