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Updated: Jul 19, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Effect of postconditioning on coronary blood flow velocity and endothelial function and LV recovery after myocardial
Xiaojing Ma1, Xinghua Zhang, Chunmei Li
1Department of Cardiology, Shandong Provincial Hospital of Shandong University, Jinan, China.
Insights
Postconditioning improves coronary blood flow and endothelial function in acute myocardial infarction patients undergoing percutaneous coronary intervention (PCI). This simple procedure salvages heart muscle and enhances recovery, offering a better prognosis.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Myocardial Protection Strategies
Background:
- Ischemia-reperfusion injury remains a significant concern in acute myocardial infarction (AMI) management.
- Percutaneous coronary intervention (PCI) is a primary revascularization strategy, but myocardial damage can persist.
- Postconditioning emerges as a potential therapeutic approach to mitigate ischemia-reperfusion injury.
Purpose of the Study:
- To evaluate the impact of postconditioning on coronary blood flow velocity in AMI patients undergoing primary PCI.
- To assess the effect of postconditioning on endothelial function following PCI.
- To investigate the protective effects of postconditioning on cardiomyocyte injury and cardiac function recovery.
Main Methods:
- Ninety-four AMI patients undergoing primary PCI were randomized into an ischemia-reperfusion (IR) group or a postconditioning (Postcond) group.
- Coronary blood flow velocity was assessed using Corrected TIMI Frame Count (CTFC).
- Biomarkers (CK, CK-MB, MDA), brachial artery endothelial function, and left ventricular wall motion score index (WMSI) were evaluated.
Main Results:
- Postconditioning significantly improved CTFC and led to a greater improvement in WMSI after 8 weeks compared to the IR group.
- The Postcond group exhibited lower peak CK and CK-MB levels and reduced MDA-reactive products post-PCI.
- Endothelium-dependent vasodilation function, depressed in all AMI patients, showed significant improvement in the Postcond group.
Conclusions:
- Postconditioning is a simple and effective procedure for salvaging coronary endothelial function and cardiomyocytes in AMI patients.
- The technique demonstrates potential for widespread clinical application to improve outcomes after AMI.
- Postconditioning offers a promising strategy to enhance myocardial protection and patient prognosis following primary PCI.
Objective:
Postconditioning is a novel approach to myocardial protection during ischemia reperfusion. Our study observed the effect of postconditioning on coronary blood flow velocity and endothelial function in patients who underwent emergency percutaneous coronary intervention (PCI).
Methods:
Ninety-four patients with their first acute myocardial infarction who underwent revascularization within 12 hours of onset by primary PCI were recruited in the study. All the patients were randomized to two groups, IR group (PCI without postconditioning) and Postcond group (PCI with postconditioning). Corrected TIMI frame count (CTFC) was used to evaluate velocity of coronary blood after PCI. Creatine phosphokinase (CK), CK-MB, and malondialdehyde (MDA) were measured before and after PCI. Arterial endothelial function was studied noninvasively by examination of brachial artery responses to endothelium-dependent and endothelium-independent stimuli by echo Doppler technique. Wall motion score index (WMSI) was assessed by two-dimensional echocardiography before and 8 weeks after angioplasty.
Results:
There were no significant differences between the two groups with regard to age, sex, presence of angiographically visible collaterals, and elapsed time from the onset of symptoms until perfusion. Patients with postconditioning had much faster CTFC than patients without postconditioning (25.38 +/- 5.35 vs 29.23 +/- 5.54). After 8 weeks, the WMSI improved significantly in both groups, but the DeltaWMSI in Postcond group was significantly larger than that of IR group (1.20 +/- 0.30 vs 1.04 +/- 0.36, P < 0.05). There was a significant negative correlation between DeltaWMSI and CTFC in IR group and Postcond group (r = -0.9032, P < 0.01; r = -0.7884, P < 0.01). The peaks of CK and CK-MB of Postcond group were much lower than that of IR group (1236.57 +/- 813.21 U/L vs 1697.36 +/- 965.74 U/L; 116.92 +/- 75.83 U/L vs 172.41 +/- 92.64 U/L), and MDA-reactive products were significantly lower than that in the IR group at any same time after PCI. All patients with acute myocardial infarction had a depressed endothelium-dependent vasodilation function, while the endothelium-dependent vasodilation function was improved in Postcond group.
Conclusion:
Postconditioning is a simple, operative procedure for salvaging the coronary endothelial function and cardiomyocyte. It could be used widely in clinic and to better the prognosis of acute myocardial infarction.
