. 2012 Apr;1(1):13–32. doi: 10.1177/2048872612438805

Table 1.

Major studies investigating ischaemic postconditioning as adjunct to primary percutaneous coronary intervention

Study	Patients	Patient eligibility: (1) STEMI type; (2) Presentation time (3) TIMI flow (4) Rentrop	Ischaemic time (min); AAR (%LV)	IPost protocol	Outcome measures	Notes
Staat et al. (2005)¹³	30	LAD/RCA STEMI	331 C	Four 60-s inflations/deflations	36%↓ in 72 h AUC CK	First application of IPost in STEMI patients
		<6 h	318 IPost		34% ↓ in peak CK
		TIMI 0 flow	34% C		MBG ↑ 1.7 to 2.4
		Rentrop <1	37% IPost
Laskey et al. (2005)⁵²	17	All STEMI	286 C	Two cycles of 1.5 min inflation/3–5 min deflations	Improved coronary blood flow
		NA	341 IPost		Better ST-segment resolution
		All TIMI flow	NA
		Collaterals included
Ma et al. (2006)⁵³	94	All STEMI	426 C	Three 30-s inflations/deflations	28% ↓ peak C
		<12 h	395 IPost		32% ↓ peak CK-MB
		All TIMI flow	NA		↓ serum MDA
		Collaterals included			Improved coronary blood flow
					Better endothelial function
					Better WMSI at 8 weeks
Yang et al. (2007)⁵⁴	41	All STEMI	264 C	Three 30-s inflations/deflations	27% ↓ 72 h AUC total CK	First study to show ↓ MI size by imaging
		NA	312 IPost		27% ↓ MI size at 7 days by SPECT
		TIMI 0 flow	NA
		Rentrop <1
Laskey et al. (2008)⁵⁵	24	LAD STEMI	222 C	Two cycles of 1.5 min inflation/4–5 min deflations	19% ↓ peak total CK level
		<6 h	228 IPost		Improved coronary flow velocity reserve
		TIMI 0–1 flow	NA		Better ST-segment resolution
		No collateral flow
Thibault et al. (2008)⁵⁶	38	LAD/RCA STEMI	297 C	Four 60-s inflations/deflations	40% ↓ 72 h AUC CK	First study to demonstrate long-term cardioprotection with IPost
		<6 h	283 IPost		41% ↓ 72 h AUC CK-MB
		TIMI 0 flow	39% C		39% ↓ MI size at 6 months by SPECT
		Rentrop <1	40% IPost		7% ↑ EF by echo at 1 year
Zhao et al. (2009)⁵⁷	75	All STEMI	268 C	Three 30-s or 60 s inflations/deflations	↓ in plasma apoptotic marker sFas	Three 60-s IPost protocol more effective
		<6 h	288 IPost
		TIMI 0–1 flow
		Rentrop <2
Lonborg et al. (2010)⁵⁸	118	All STEMI	255 C	Four 30-s inflations/deflations	No difference in troponin T or LVEF	Largest IPost study to date
		<12 h	241 IPost		19% ↓ MI size at 3 months by CMR	First to use CMR to assess IPost
		TIMI 0 flow	29% C		31% ↑ in myocardial salvage index
		Collaterals included	29% IPost		Less heart failure (27% vs. 46%)
Xue et al. (2010)⁵⁹	43	All STEMI	324 C	Four 60-s inflations/deflations	Better ST-segment resolution
		<12 h	246 IPost		26% ↓ 72 h AUC CK-MB
		TIMI 0 flow			46% ↓ in MI size at 7 days by SPECT
		Rentrop <2			↓ levels of hs-C-reactive protein
					10% ↑ in EF
Lin et al. (2010)⁶⁰	74	All STEMI	NA	Three 30-s or 60 s inflations/deflations	↑ in EF and WMSI at 1 year	Three 60-s IPost protocol more effective
		<12 h			↓ levels of tumour necrosis factor α
		TIMI 0 flow
		Rentrop <2
Fan et al. (2010)⁶¹	50	All STEMI	268 C	Three 30-s inflations/deflations	↓ inducible nitric oxide synthase activity in white blood cells
		NA	288 IPost		Decreased plasma nitrotyrosine
		TIMI 0–1 flow			Improved cardiac function
		Rentrop <2
Sorensson et al. (2010)¹⁷	76	All STEMI	185 C	Four 60-s inflations/deflations	No difference in 48 h AUC CK-MB and troponin T	First negative study, although IPost effective in those patients with large AAR (>30%) or LAD infarcts
		<6 h	165 IPost		No difference in myocardial salvage by CMR at day 7–9
		TIMI 0 flow	23% C		Significant increase in myocardial salvage in patients with large AAR (>30% of LV)
		Rentrop <2	30% IPost
Garcia et al. (2010)⁶²	43	All STEMI	270 C	Four 30-s inflations/deflations	11% ↓ peak CK
		<12 h	270 IPost		20% ↓ peak CK-MB
		TIMI 0 flow			Increased MBG
		Rentrop <1			9% ↑ in EF
Limalanathan et al. (2010) ⁶³POSTEMI		All STEMI		Four 60-s inflations/deflations	Ongoing
		<6 h
		TIMI 0 flow
		Rentrop <1
Tarantini et al. (2010)⁶⁴ (POST-AMI)	78	All STEMI	NA	Four 60-s inflations/deflations	Ongoing
		<6 h			Endpoints include AUC or peak troponin I
		TIMI 0 flow			MI size at 30 d by CMR with IPost
		Rentrop <1
Engstrom et al. (DANAMI-3)	2000	All STEMI	NA	Four 30-s inflations/deflations	Ongoing	Large outcome-based study
		<12 h			Primary combined endpoint is cardiac death, re-infarction, and heart failure at 3 years
Ovize et al. (PRIME)	72	LAD/RCA STEMI	NA	Four 60-s inflations/deflations	Ongoing	Tests if IPost is effective in patients who spontaneously reperfuse
		<12 h			Primary endpoint is MI size by CMR at 5 d
		TIMI 2–3 flow
		Rentrop <1

AUC, area under the curve; AAR, area at risk; C, control; CK, creatine kinase; CMR, cardiac MRI; EF, ejection fraction; IPost, ischaemic postconditioning; LAD, left anterior descending coronary artery; LV, left ventricular; MBG, myocardial blush grade; MDA, malondialdehyde; MI, myocardial infarct; RCA, right coronary artery; SPECT, single photon emission CT; STEMI, ST-segment elevation MI; TIMI, thrombolysis in myocardial infarction; WMSI, wall motion score index.