Interaction of ischaemic postconditioning and thrombectomy in patients with ST-elevation myocardial infarction

ObjectiveThe Third Danish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction – Ischaemic Postconditioning (DANAMI-3-iPOST) did not show improved clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI) treated with ischaemic postc...

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Veröffentlicht in:Heart (British Cardiac Society) 2020-01, Vol.106 (1), p.24-32
Hauptverfasser: Nepper-Christensen, Lars, Høfsten, Dan Eik, Helqvist, Steffen, Lassen, Jens Flensted, Tilsted, Hans-Henrik, Holmvang, Lene, Pedersen, Frants, Joshi, Francis, Sørensen, Rikke, Bang, Lia, Bøtker, Hans Erik, Terkelsen, Christian Juhl, Maeng, Michael, Jensen, Lisette Okkels, Aarøe, Jens, Kelbæk, Henning, Køber, Lars, Engstrøm, Thomas, Lønborg, Jacob
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container_end_page 32
container_issue 1
container_start_page 24
container_title Heart (British Cardiac Society)
container_volume 106
creator Nepper-Christensen, Lars
Høfsten, Dan Eik
Helqvist, Steffen
Lassen, Jens Flensted
Tilsted, Hans-Henrik
Holmvang, Lene
Pedersen, Frants
Joshi, Francis
Sørensen, Rikke
Bang, Lia
Bøtker, Hans Erik
Terkelsen, Christian Juhl
Maeng, Michael
Jensen, Lisette Okkels
Aarøe, Jens
Kelbæk, Henning
Køber, Lars
Engstrøm, Thomas
Lønborg, Jacob
description ObjectiveThe Third Danish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction – Ischaemic Postconditioning (DANAMI-3-iPOST) did not show improved clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI) treated with ischaemic postconditioning. However, the use of thrombectomy was frequent and thrombectomy may in itself diminish the effect of ischaemic postconditioning. We evaluated the effect of ischaemic postconditioning in patients included in DANAMI-3-iPOST stratified by the use of thrombectomy.MethodsPatients with STEMI were randomised to conventional primary percutaneous coronary intervention (PCI) or ischaemic postconditioning plus primary PCI. The primary endpoint was a combination of all-cause mortality and hospitalisation for heart failure.ResultsFrom March 2011 until February 2014, 1234 patients were included with a median follow-up period of 35 (interquartile range 28 to 42) months. There was a significant interaction between ischaemic postconditioning and thrombectomy on the primary endpoint (p=0.004). In patients not treated with thrombectomy (n=520), the primary endpoint occurred in 33 patients (10%) who underwent ischaemic postconditioning (n=326) and in 35 patients (18%) who underwent conventional treatment (n=194) (adjusted hazard ratio (HR) 0.55 (95%confidence interval (CI) 0.34 to 0.89), p=0.016). In patients treated with thrombectomy (n=714), there was no significant difference between patients treated with ischaemic postconditioning (n=291) and conventional PCI (n=423) on the primary endpoint (adjusted HR 1.18 (95% CI 0.62 to 2.28), p=0.62).ConclusionsIn this post-hoc study of DANAMI-3-iPOST, ischaemic postconditioning, in addition to primary PCI, was associated with reduced risk of all-cause mortality and hospitalisation for heart failure in patients with STEMI not treated with thrombectomy.Trial registration number NCT01435408.
doi_str_mv 10.1136/heartjnl-2019-314952
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However, the use of thrombectomy was frequent and thrombectomy may in itself diminish the effect of ischaemic postconditioning. We evaluated the effect of ischaemic postconditioning in patients included in DANAMI-3-iPOST stratified by the use of thrombectomy.MethodsPatients with STEMI were randomised to conventional primary percutaneous coronary intervention (PCI) or ischaemic postconditioning plus primary PCI. The primary endpoint was a combination of all-cause mortality and hospitalisation for heart failure.ResultsFrom March 2011 until February 2014, 1234 patients were included with a median follow-up period of 35 (interquartile range 28 to 42) months. There was a significant interaction between ischaemic postconditioning and thrombectomy on the primary endpoint (p=0.004). In patients not treated with thrombectomy (n=520), the primary endpoint occurred in 33 patients (10%) who underwent ischaemic postconditioning (n=326) and in 35 patients (18%) who underwent conventional treatment (n=194) (adjusted hazard ratio (HR) 0.55 (95%confidence interval (CI) 0.34 to 0.89), p=0.016). In patients treated with thrombectomy (n=714), there was no significant difference between patients treated with ischaemic postconditioning (n=291) and conventional PCI (n=423) on the primary endpoint (adjusted HR 1.18 (95% CI 0.62 to 2.28), p=0.62).ConclusionsIn this post-hoc study of DANAMI-3-iPOST, ischaemic postconditioning, in addition to primary PCI, was associated with reduced risk of all-cause mortality and hospitalisation for heart failure in patients with STEMI not treated with thrombectomy.Trial registration number NCT01435408.</description><identifier>ISSN: 1355-6037</identifier><identifier>EISSN: 1468-201X</identifier><identifier>DOI: 10.1136/heartjnl-2019-314952</identifier><identifier>PMID: 31315939</identifier><language>eng</language><publisher>England: BMJ Publishing Group Ltd and British Cardiovascular Society</publisher><subject>Acute coronary syndromes ; acute myocardial infarction ; Angioplasty ; Clinical trials ; Coronary artery disease ; Diabetes ; Glycoproteins ; Heart attacks ; Heart failure ; Mortality ; Patients ; percutaneous coronary intervention ; Survival analysis ; Variables ; Veins &amp; arteries</subject><ispartof>Heart (British Cardiac Society), 2020-01, Vol.106 (1), p.24-32</ispartof><rights>Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2020 Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b416t-d10990dafac9d55e9e89e96352174168aefe2940100b160217acdb2eddab54f43</citedby><cites>FETCH-LOGICAL-b416t-d10990dafac9d55e9e89e96352174168aefe2940100b160217acdb2eddab54f43</cites><orcidid>0000-0002-1821-9428</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31315939$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nepper-Christensen, Lars</creatorcontrib><creatorcontrib>Høfsten, Dan Eik</creatorcontrib><creatorcontrib>Helqvist, Steffen</creatorcontrib><creatorcontrib>Lassen, Jens Flensted</creatorcontrib><creatorcontrib>Tilsted, Hans-Henrik</creatorcontrib><creatorcontrib>Holmvang, Lene</creatorcontrib><creatorcontrib>Pedersen, Frants</creatorcontrib><creatorcontrib>Joshi, Francis</creatorcontrib><creatorcontrib>Sørensen, Rikke</creatorcontrib><creatorcontrib>Bang, Lia</creatorcontrib><creatorcontrib>Bøtker, Hans Erik</creatorcontrib><creatorcontrib>Terkelsen, Christian Juhl</creatorcontrib><creatorcontrib>Maeng, Michael</creatorcontrib><creatorcontrib>Jensen, Lisette Okkels</creatorcontrib><creatorcontrib>Aarøe, Jens</creatorcontrib><creatorcontrib>Kelbæk, Henning</creatorcontrib><creatorcontrib>Køber, Lars</creatorcontrib><creatorcontrib>Engstrøm, Thomas</creatorcontrib><creatorcontrib>Lønborg, Jacob</creatorcontrib><title>Interaction of ischaemic postconditioning and thrombectomy in patients with ST-elevation myocardial infarction</title><title>Heart (British Cardiac Society)</title><addtitle>Heart</addtitle><addtitle>Heart</addtitle><description>ObjectiveThe Third Danish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction – Ischaemic Postconditioning (DANAMI-3-iPOST) did not show improved clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI) treated with ischaemic postconditioning. However, the use of thrombectomy was frequent and thrombectomy may in itself diminish the effect of ischaemic postconditioning. We evaluated the effect of ischaemic postconditioning in patients included in DANAMI-3-iPOST stratified by the use of thrombectomy.MethodsPatients with STEMI were randomised to conventional primary percutaneous coronary intervention (PCI) or ischaemic postconditioning plus primary PCI. The primary endpoint was a combination of all-cause mortality and hospitalisation for heart failure.ResultsFrom March 2011 until February 2014, 1234 patients were included with a median follow-up period of 35 (interquartile range 28 to 42) months. There was a significant interaction between ischaemic postconditioning and thrombectomy on the primary endpoint (p=0.004). In patients not treated with thrombectomy (n=520), the primary endpoint occurred in 33 patients (10%) who underwent ischaemic postconditioning (n=326) and in 35 patients (18%) who underwent conventional treatment (n=194) (adjusted hazard ratio (HR) 0.55 (95%confidence interval (CI) 0.34 to 0.89), p=0.016). In patients treated with thrombectomy (n=714), there was no significant difference between patients treated with ischaemic postconditioning (n=291) and conventional PCI (n=423) on the primary endpoint (adjusted HR 1.18 (95% CI 0.62 to 2.28), p=0.62).ConclusionsIn this post-hoc study of DANAMI-3-iPOST, ischaemic postconditioning, in addition to primary PCI, was associated with reduced risk of all-cause mortality and hospitalisation for heart failure in patients with STEMI not treated with thrombectomy.Trial registration number NCT01435408.</description><subject>Acute coronary syndromes</subject><subject>acute myocardial infarction</subject><subject>Angioplasty</subject><subject>Clinical trials</subject><subject>Coronary artery disease</subject><subject>Diabetes</subject><subject>Glycoproteins</subject><subject>Heart attacks</subject><subject>Heart failure</subject><subject>Mortality</subject><subject>Patients</subject><subject>percutaneous coronary intervention</subject><subject>Survival analysis</subject><subject>Variables</subject><subject>Veins &amp; 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However, the use of thrombectomy was frequent and thrombectomy may in itself diminish the effect of ischaemic postconditioning. We evaluated the effect of ischaemic postconditioning in patients included in DANAMI-3-iPOST stratified by the use of thrombectomy.MethodsPatients with STEMI were randomised to conventional primary percutaneous coronary intervention (PCI) or ischaemic postconditioning plus primary PCI. The primary endpoint was a combination of all-cause mortality and hospitalisation for heart failure.ResultsFrom March 2011 until February 2014, 1234 patients were included with a median follow-up period of 35 (interquartile range 28 to 42) months. There was a significant interaction between ischaemic postconditioning and thrombectomy on the primary endpoint (p=0.004). In patients not treated with thrombectomy (n=520), the primary endpoint occurred in 33 patients (10%) who underwent ischaemic postconditioning (n=326) and in 35 patients (18%) who underwent conventional treatment (n=194) (adjusted hazard ratio (HR) 0.55 (95%confidence interval (CI) 0.34 to 0.89), p=0.016). In patients treated with thrombectomy (n=714), there was no significant difference between patients treated with ischaemic postconditioning (n=291) and conventional PCI (n=423) on the primary endpoint (adjusted HR 1.18 (95% CI 0.62 to 2.28), p=0.62).ConclusionsIn this post-hoc study of DANAMI-3-iPOST, ischaemic postconditioning, in addition to primary PCI, was associated with reduced risk of all-cause mortality and hospitalisation for heart failure in patients with STEMI not treated with thrombectomy.Trial registration number NCT01435408.</abstract><cop>England</cop><pub>BMJ Publishing Group Ltd and British Cardiovascular Society</pub><pmid>31315939</pmid><doi>10.1136/heartjnl-2019-314952</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-1821-9428</orcidid></addata></record>
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subjects Acute coronary syndromes
acute myocardial infarction
Angioplasty
Clinical trials
Coronary artery disease
Diabetes
Glycoproteins
Heart attacks
Heart failure
Mortality
Patients
percutaneous coronary intervention
Survival analysis
Variables
Veins & arteries
title Interaction of ischaemic postconditioning and thrombectomy in patients with ST-elevation myocardial infarction
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