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'Postconditioning' the human heart: multiple balloon inflations during primary angioplasty may confer
Chad E Darling1, Patrick B Solari, Craig S Smith
1Dept. of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue, North Worcester , MA, 01655, USA.
Insights
Stuttering reperfusion during angioplasty, termed postconditioning, may protect the heart. STEMI patients needing multiple balloon inflations had less heart muscle damage (creatine kinase release) than those with fewer inflations.
Area of Science:
- Cardiology
- Experimental Medicine
Background:
- Experimental models indicate stuttering reperfusion (postconditioning) limits myocardial infarct size.
- Clinical efficacy of postconditioning in ST-segment elevation myocardial infarction (STEMI) remains largely unexplored.
Purpose of the Study:
- To test if creatine kinase (CK) release, a marker of infarct size, is reduced in STEMI patients undergoing multiple balloon inflations during primary angioplasty compared to those with minimal inflations.
Main Methods:
- Retrospective study of STEMI patients undergoing primary angioplasty for single vessel occlusion.
- Patients divided into two groups: 1-3 balloon inflations vs. 4 or more inflations.
- Exclusion criteria included prior MI, cardiogenic shock, cardiac arrest resuscitation, or pre-infarct angina.
Main Results:
- Peak CK release was significantly lower in patients requiring 4 or more balloon inflations (1655 IU/L) versus those requiring 1-3 inflations (2272 IU/L; p<0.05).
Conclusions:
- Stuttered relief of myocardial ischemia during angioplasty, analogous to postconditioning, may offer cardioprotection in STEMI patients.
- Multiple balloon inflations during primary angioplasty may be a clinical strategy to limit infarct size.
Abstract:
Growing evidence from experimental models suggests that relief of myocardial ischemia in a stuttering manner (i.e., 'postconditioning' [PostC] with brief cycles of reperfusion-reocclusion) limits infarct size. However, the potential clinical efficacy of PostC has, to date,been largely unexplored. Using a retrospective study design, our aim was to test the hypothesis that creatine kinase release (CK: clinical surrogate of infarct size) would be attenuated in ST-segment elevation myocardial infarction (STEMI) patients requiring multiple balloon inflations-deflations during primary angioplasty versus STEMI patients who received minimal balloon inflations and/or direct stenting. To investigate this concept, we reviewed the records of all STEMI patients with single vessel occlusion who presented to our institution from November 2004 - April 2006 for primary angioplasty. Exclusion criteria were: previous MI, cardiogenic shock, patients resuscitated from cardiac arrest, or pre-infarct angina. Patients were prospectively divided into two subsets: those receiving 1-3 balloon inflations (considered the minimum range to achieve patency and stent placement) versus those in whom 4 or more inflations were applied. Peak CK release was significantly lower in patients requiring > or =4 versus 1-3 inflations (1655 versus 2272 IU/L; p<0.05), an outcome consistent with the concept that relief of sustained ischemia in a stuttered manner (analogous to postconditioning) may evoke cardioprotection in the clinical setting.
