Impact of Ischemic Postconditioning on Outcome in Patients with Anterior ST-Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

Gad, Marwa Mohamed; Ahmed, Ahmed Fathy; Elbakry, Abdelkader Abd Elrahman Abd Elk; Allam, Mohamed Maher Ahmed

doi:10.21608/zumj.2025.381739.3939

Impact of Ischemic Postconditioning on Outcome in Patients with Anterior ST-Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

Document Type : Original Article

Authors

¹ Assistant Professor of Cardiology, Faculty of Medicine, Zagazig University

² Professor of Cardiology, Faculty of Medicine, Zagazig University

³ M.B.B.Ch., Faculty of Medicine, Zagazig University

10.21608/zumj.2025.381739.3939

Abstract

Background: Reperfusion therapy remains important for managing of ST-segment elevation myocardial infarction (STEMI), it carries the risk of additional myocardial injury. Ischemic postconditioning (iPOST) has been proposed to minimize that injury. The purpose of this research was to evaluate the effectiveness of ischemic postconditioning in improving cardiac outcomes and reducing heart failure incidence among anterior STEMI patients undergoing primary percutaneous coronary intervention (PPCI).

Methods: In this prospective case-control study, 78 patients with anterior STEMI were categorized into two groups: 39 underwent iPOST during PPCI, and 39 received conventional PPCI. Clinical outcomes, serial cardiac biomarkers (CK-MB, troponin I), ejection fraction (EF), in addition to the wall motion score index were all assessed at baseline, discharge.

Results: Patients in the iPOST group had statistically significantly lower CK-MB as well as troponin I levels at twelve-, and twenty-four-hours post-procedure (p<0.001), in addition to greater improvement in EF at discharge and follow-up (p<0.001). In-hospital heart failure rate was statistically significantly decreased in the iPOST group (5.1% vs. 28.2%, p=0.015), as the incidence of myocardial infarction during follow-up was higher in the conventional group (23.1%) compared to the postconditioning group (5.1%), yielding an absolute risk difference of 18% (95% CI: 1.3–34.7%, p = 0.04)..Multivariate analysis revealed that postconditioning independently predicted a lower risk of heart failure (OR=0.07, p=0.035).

Conclusion: Ischemic postconditioning during PPCI appears to offer statistically significant cardioprotective benefits among anterior STEMI patients, by reducing cardiac enzyme release, enhancing left ventricular function, in addition to lowering heart failure incidence.

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