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

Lars Nepper-Christensen; Dan Eik Høfsten; Steffen Helqvist; Jens Flensted Lassen; Hans-Henrik Tilsted; Lene Holmvang; Frants Pedersen; Francis Joshi; Rikke Sørensen; Lia Bang; Hans Erik Bøtker; Christian Juhl Terkelsen; Michael Maeng; Lisette Okkels Jensen; Jens Aarøe; Henning Kelbæk; Lars Køber; Thomas Engstrøm; Jacob Lønborg

doi:10.1136/heartjnl-2019-314952

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

Lars Nepper-Christensen, Dan Eik Høfsten, Steffen Helqvist, Jens Flensted Lassen, Hans-Henrik Tilsted, Lene Holmvang, Frants Pedersen, Francis Joshi, Rikke Sørensen, Lia Bang, Hans Erik Bøtker, Christian Juhl Terkelsen, Michael Maeng, Lisette Okkels Jensen, Jens Aarøe, Henning Kelbæk, Lars Køber, Thomas Engstrøm, Jacob Lønborg

Kardiologisk Afdeling

Publikation: Bidrag til tidsskrift › Artikel › Forskning › peer review

Abstract

OBJECTIVE: The 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.

METHODS: Patients 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.

RESULTS: From 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).

CONCLUSIONS: In 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.

Originalsprog	Engelsk
Sider (fra-til)	24-32
Antal sider	9
Tidsskrift	Heart
Vol/bind	106
Udgave nummer	1
Tidlig onlinedato	17 jul. 2019
DOI	https://doi.org/10.1136/heartjnl-2019-314952
Status	Udgivet - jan. 2020

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10.1136/heartjnl-2019-314952

Citationsformater

Nepper-Christensen, L., Høfsten, D. E., Helqvist, S., Lassen, J. F., Tilsted, H.-H., Holmvang, L., Pedersen, F., Joshi, F., Sørensen, R., Bang, L., Bøtker, H. E., Terkelsen, C. J., Maeng, M., Jensen, L. O., Aarøe, J., Kelbæk, H., Køber, L., Engstrøm, T., & Lønborg, J. (2020). Interaction of ischaemic postconditioning and thrombectomy in patients with ST-elevation myocardial infarction. Heart, 106(1), 24-32. https://doi.org/10.1136/heartjnl-2019-314952

@article{dd4acb764468406d968d8c13b6e02582,

title = "Interaction of ischaemic postconditioning and thrombectomy in patients with ST-elevation myocardial infarction",

abstract = "OBJECTIVE: The 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.METHODS: Patients 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.RESULTS: From 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).CONCLUSIONS: In 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.",

author = "Lars Nepper-Christensen and H{\o}fsten, {Dan Eik} and Steffen Helqvist and Lassen, {Jens Flensted} and Hans-Henrik Tilsted and Lene Holmvang and Frants Pedersen and Francis Joshi and Rikke S{\o}rensen and Lia Bang and B{\o}tker, {Hans Erik} and Terkelsen, {Christian Juhl} and Michael Maeng and Jensen, {Lisette Okkels} and Jens Aar{\o}e and Henning Kelb{\ae}k and Lars K{\o}ber and Thomas Engstr{\o}m and Jacob L{\o}nborg",

note = "� Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2020",

month = jan,

doi = "10.1136/heartjnl-2019-314952",

language = "English",

volume = "106",

pages = "24--32",

journal = "Heart",

issn = "1355-6037",

publisher = "BMJ Publishing Group",

number = "1",

}

Nepper-Christensen, L, Høfsten, DE, Helqvist, S, Lassen, JF, Tilsted, H-H, Holmvang, L, Pedersen, F, Joshi, F, Sørensen, R, Bang, L, Bøtker, HE, Terkelsen, CJ, Maeng, M, Jensen, LO, Aarøe, J, Kelbæk, H, Køber, L, Engstrøm, T & Lønborg, J 2020, 'Interaction of ischaemic postconditioning and thrombectomy in patients with ST-elevation myocardial infarction', Heart, bind 106, nr. 1, s. 24-32. https://doi.org/10.1136/heartjnl-2019-314952

TY - JOUR

T1 - Interaction of ischaemic postconditioning and thrombectomy in patients with ST-elevation myocardial infarction

AU - Nepper-Christensen, Lars

AU - Høfsten, Dan Eik

AU - Helqvist, Steffen

AU - Lassen, Jens Flensted

AU - Tilsted, Hans-Henrik

AU - Holmvang, Lene

AU - Pedersen, Frants

AU - Joshi, Francis

AU - Sørensen, Rikke

AU - Bang, Lia

AU - Bøtker, Hans Erik

AU - Terkelsen, Christian Juhl

AU - Maeng, Michael

AU - Jensen, Lisette Okkels

AU - Aarøe, Jens

AU - Kelbæk, Henning

AU - Køber, Lars

AU - Engstrøm, Thomas

AU - Lønborg, Jacob

N1 - � Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2020/1

Y1 - 2020/1

N2 - OBJECTIVE: The 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.METHODS: Patients 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.RESULTS: From 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).CONCLUSIONS: In 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.

AB - OBJECTIVE: The 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.METHODS: Patients 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.RESULTS: From 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).CONCLUSIONS: In 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.

U2 - 10.1136/heartjnl-2019-314952

DO - 10.1136/heartjnl-2019-314952

M3 - Article

C2 - 31315939

SN - 1355-6037

VL - 106

SP - 24

EP - 32

JO - Heart

JF - Heart

IS - 1

ER -

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

Abstract

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