Ischemic Postconditioning Before Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction Reduces Contrast-induced Nephropathy and Improves Long-term Prognosis.
BACKGROUND AND AIMS
Contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) is one of the major adverse outcomes affecting the prognosis of patients with acute ST-segment elevation myocardial infarction (STEMI). Ischemic postconditioning prior to PCI (pre-PCI) in patients with STEMI is hypothesized to be protective against CIN after PCI.


METHODS
A total of 251 patients with STEMI were randomized into two groups: ischemic postconditioning group (n = 123, age, 61.1 ± 12.5 years) who underwent ischemic postconditioning prior to PCI; control group (n = 128; age, 64.1 ± 12.1 years) who underwent only PCI. Ischemic postconditioning was administered by three cycles of deflation and inflation of the balloon (1-min ischemia and 1-min reperfusion) starting 1 min after infarct-related artery (IRA) opening. Diagnostic criterion for CIN was: increase in serum creatinine level by ≥0.5 mg/dL or by ≥25% increase from preoperative level within 48 h of surgery. All patients were followed for 1 year for incidence of major cardiovascular events (MACE).


RESULTS
The incidence of postoperative CIN in the ischemic postconditioning group was 5.69% as compared to 14.06% in the control group (p <0.05). At one year, the MACE incidence in the ischemic postconditioning group was 7.32% as compared to 15.63% in the control group (p <0.05).


CONCLUSIONS
Pre-PCI ischemic postconditioning in STEMI patients significantly reduces the post-PCI incidence of CIN and improves long-term prognosis.
['Wang|Yun-Yun|YY|', 'Li|Tong|T|', 'Liu|Ying-Wu|YW|', 'Wang|Yu|Y|', 'Hu|Xiao-Min|XM|', 'Gao|Wen-Qing|WQ|', 'Wu|Peng|P|', 'Li|Xin|X|', 'Peng|Wen-Jin|WJ|', 'Gao|Wei|W|', 'Yu|Guang-Dong|GD|', 'Liu|Bo-Jiang|BJ|']
D000368:Aged D003287:Contrast Media D005260:Female D006801:Humans D057775:Ischemic Postconditioning D007674:Kidney Diseases D008297:Male D008875:Middle Aged D009203:Myocardial Infarction D062645:Percutaneous Coronary Intervention D011379:Prognosis D016896:Treatment Outcome
Ischemic postconditioning Percutaneous coronary intervention Contrast-induced nephropathy Acute myocardial infarction Long term prognosis