Rapid reperfusion of the infarct-related coronary artery is essential in the treatment of acute ST-elevation myocardial infarction (STEMI). Paradoxically, restoration of the blood flow to the ischemic area may result in further injury to the myocardium. This phenomenon is described as ‘ischemia/reperfusion injury’ and the pathophysiological mechanisms are not fully elucidated. A cardioprotective effect of ischemic postconditioning (short repetitive cycles of reperfusion and re-occlusion) has been demonstrated in experimental studies and in pilot studies on patients with acute STEMI treated with primary percutaneous coronary intervention. We present the study design of the Postconditioning in ST-Elevation Myocardial Infarction (POSTEMI) study, which is a prospective, randomized, open-label clinical trial with blinded endpoint evaluation designed to evaluate the effect of postconditioning on final infarct size. Patients with acute STEMI with symptoms of less than 6 h and proximal or mid-coronary artery occlusion will be included. The primary endpoint is infarct size, assessed by cardiac MRI after 4 months. The secondary endpoints are to evaluate the effect of postconditioning on TIMI myocardial perfusion grade, resolution of ST-segment elevation, release of markers of ischemia, left ventricular function and final infarct size related to the area at risk. A total of 260 patients will be included in the study.

Fibrinolytic Therapy Trialists (FTT) Collaborative Group: Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 100 patients. Lancet 1994;343:311–322.
Van de Werf F, Bax J, Betriu A, et al: Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation. Eur Heart J 2008;29:2909–2945.
TIMI Study Group: Definitions used in TIMI trials. http://www.timi.org.
Ndrepa G, Mehilli J, Schulz S, et al: Prognostic significance of epicardial blood flow before and after percutaneous coronary intervention in patients with acute coronary syndromes. J Am Coll Cardiol 2008;52:512–517.
Gibson CM, Cannon CP, Murphy SA, et al: Relationship of TIMI myocardial perfusion grade to mortality after administration of thrombolytic drugs. Circulation 2000;101:125–130.
de Lemos JA, Braunwald E: ST segment resolution as a tool for assessing the efficacy of reperfusion therapy. J Am Coll Cardiol 2001;38:1283–1294.
Yellon DM, Hausenloy DJ: Myocardial reperfusion injury. N Engl J Med 2007;357:1121–1135.
Hearse DJ, Bolli R: Reperfusion induced injury: manifestations, mechanisms, and clinical relevance. Cardiovasc Res 1992;26:101–108.
Hausenloy DJ, Yellon DM: New directions for protecting the heart against ischemia-reperfusion injury: targeting the Reperfusion Injury Salvage Kinase (RISK) pathway. Cardiovasc Res 2004;61:448–460.
Hausenloy DJ, Yellon DM: The mitochondrial permeability transition pore: its fundamental role in mediating cell death during ischemia and reperfusion. J Mol Cell Cardiol 2003;35:339–341.
Hausenloy DJ, Duchen MR, Yellon DM: Inhibiting mitochondrial permeability transition pore opening at reperfusion protects against ischemia reperfusion injury. Cardiovasc Res 2003;60:617–625.
Piot C, Croisille P, Staat P, et al: Effect of cyclosporine on reperfusion injury in acute myocardial infarction. N Engl J Med 2008;359:473–481.
Atar D, Petzelbauer P, Schwitter J, et al: Effect of intravenous FX06 as an adjunct to primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction. J Am Coll Cardiol 2009;53:720–729.
Murry CE, Jennings RB, Reimer KA: Preconditioning with ischemia: a delay of lethal injury in ischemic myocardium. Circulation 1986;74:1124–1136.
Granfeldt A, Lefer DJ, Vinten-Johansen J: Protective ischemia in patients: preconditioning and postconditioning. Cardiovasc Res 2009;83:234–246.
Zhao ZQ, Corvera JS, Halkos ME, et al: Inhibition of myocardial injury by ischemic postconditioning during reperfusion: comparison with ischemic preconditioning. Am J Physiol Heart Circ Physiol 2003;285:H579–H588.
Laskey WK: Brief repetitive balloon occlusions enhance reperfusion during percutaneous coronary intervention for acute myocardial infarction: a pilot study. Cathet Cardiovasc Interven 2005;65:361–367.
Staat P, Rifoul G, Piot C, et al: Postconditioning the human heart. Circulation 2005;112:2143–2148.
Thibault H, Piot C, Staat P, et al: Long-term benefit of postconditioning. Circulation 2008;117:1037–1044.
Hansen P, Thibault H, Abdulla J: Postconditioning during primary percutaneous coronary intervention: a review and meta-analysis. Int J Cardiol 2009, E-pub ahead of print.
Lønborg J, Kelbæk H, et al: Cardioprotective effects of ischemic postconditioning in patients treated with primary percutaneous coronary intervention, evaluated by magnetic resonance. Circ Cardiovasc Interv 2010;3:34–41.
Moher D, Schulz KF, Altman DG; for the CONSORT Group: The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet 2001;357:1191–1194.
Gurm HS, Smith DE, Collins JS, et al: The relative safety and efficacy of abciximab and eptifibatide in patients undergoing primary percutaneous coronary intervention. J Am Coll Cardiol 2008;51:529–535.
Hoffmann P, Halvorsen S, Stensaeth KH, et al: Myocardial perfusion in ST-elevation myocardial infarction treated successfully with primary angioplasty. Scand Cardiovasc J 2006;40:96–104.
Ganame J, Messalli G, Dymarkowski S, et al: Impact of myocardial haemorrhage on left ventricular function and remodelling in patients with reperfused acute myocardial infarction. Eur Heart J 2009;30:1440–1449.
O’Regan DP, Ahmed R, Karunanithy N, et al: Reperfusion hemorrhage following acute myocardial infarction: assessment with T2* mapping and effect on measuring the area at risk. Radiology 2009;250:916–922.
Carlsson M, Ubachs JFA, Hedström E, Heiberg E, Jovinge S, Arheden H: Myocardium at risk after acute infarction in humans on cardiac magnetic resonance. J Am Coll Cardiol Img 2009;2:569–576.
Pocock SJ: Clinical Trials: A Practical Approach. Chichester, John Wiley and Sons, 1983.
Kalla K, Christ G, Karnik R, et al: Implementation of guidelines improves the standard of care: the Viennese registry on reperfusion strategies in ST-elevation myocardial infarction (Vienna STEMI Registry). Circulation 2006;113:2398–2405.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.