Myocardial Reperfusion Injury
Conditions
Keywords
Myocardial infarction, Postconditioning
Brief summary
The investigators previously reported that angioplasty postconditioning reduces infarct size (cardiac enzyme release) in STEMI patients with a fully occluded coronary artery at hospital admission. Animal studies have suggested that the time window for applying brief episodes of ischemia and reperfusion aimed at triggering postconditioning's protection is very narrow, i.e. does not expand beyond 1 minute after reflow. We sought to address whether this window might be larger in humans, i.e. whether STEMI patients might be protected several minutes after undergoing spontaneous reperfusion before admission coronary angiography. Therefore, STEMI patients (onset of chest pain less than 12 hours) with a TIMI flow grade \> 1 were eligible for that study. Angioplasty postconditioning was completed as already published and infarct size was assessed by measuring cardiac enzymes release.
Interventions
PROCEDUREPostconditioning
Postconditioning consists of four cycles of one minute balloon inflation followed by one minute of balloon deflation, with the initial inflation being started within the first minute after reopening of the culprit coronary artery.
PROCEDUREPercutaneaous intervention
Conventional primary percutaneaous intervention
Sponsors
Hospices Civils de Lyon
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patient \> 18 years old * Male or female * Presenting first myocardial infarction, with the beginning of pains \< 12 hours, * Requiring a revascularisation by primary angioplasty or rescue (after failure of thrombolysis) on LAD or RCA (not Circumflex coronary artery). * TIMI flow grade at admission of 2 or 3 * LV angiography (RAO30°) before angioplasty.
Exclusion criteria
* Cardiac arrest before the angioplasty * Cardiogenic shock * Occlusion of the artery circumflex responsible for the infarction * Visible collaterals to the area at risk * Magnetic resonance imaging: contra indication
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Size of the infarct | Day 5 post reperfusion | Size of the infarct estimated by magnetic resonance imaging at day 5 post-reperfusion |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Contractile functional recovery | 6 months after reperfusion | Contractile functional recovery estimated by echocardiography at 6th month versus before discharge. |
Countries
France
Outcome results
None listed