Staccato reperfusion prevents reperfusion injury in patients undergoing coronary angioplasty: A 1-year follow-up pilot study

Background: Adjunctive interventions protect from reperfusion injury during primary percutaneous coronary intervention (PCI), but it is not known whether they are also protective during elective PCI. We sought to assess the efficacy of staccato reperfusion (SR) during PCI. Methods: Thirty seven patients with recent acute coronary syndrome and target lesions of 85-100% were randomized to SR (n = 18), consisting of 6 periods of 10-s balloon inflation/deflation (total time, 120 sec) or abrupt reperfusion (AR, n = 19), consisting of a single continuous 120-s balloon inflation; subsequently, all underwent stent implantation. Left ventricular wall motion score was echocardiography determined at baseline, 10 days and 1 year later. The oxidative markers malondialdehyde (MDA) and nitrotyrosine were assessed at baseline, 3 and 18 min after PCI. Patients were also followed for 1 year for major events (death, non-fatal myocardial infarction or revascularization). Results: Wall motion score index (SR: 1.34 +/- 0.29 (baseline), 1.17 +/- 0.17 (10-day), 1.08 +/- 0.12 (1-year); AR: 1.33 +/- 0.22, 1.27 +/- 0.20, 1.24 +/- 0.22, respectively) improved significantly as a result of SR (F= 8.951, p = 0.002). Similarly, the biomarkers of oxidative injury, MDA (1.74 +/- 0.49 mu mol/L in SR vs. 2.45 +/- 1.26 mu mol/L in AR, p = 0.002) and nitrotyrosine (5.23 +/- 5.58 nmol/L in SR vs. 9.79 +/- 7.83 nmol/L in AR, p = 0.003) measured 18 min after PCI were significantly lower in SR. No major events occurred. Conclusions: SR can improve long-term wall motion score during PCI, at least partly through the attenuation of a reperfusion-type oxidative injury that also occurs in these patients. (C) 2008 Elsevier Ireland Ltd. All rights reserved.