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Updated: Jun 21, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Beneficial effect of reperfusion therapy beyond the preservation of left ventricular function in patients with acute
Uwe Zeymer1, Timm Bauer, Bernard J Gersh
1Herzzentrum Ludwigshafen, Medizinische Klink B, Ludwigshafen, Germany. Uwe.Zeymer@t-online.de
Insights
Early reperfusion therapy significantly improves survival in ST-segment elevation myocardial infarction patients, regardless of left ventricular ejection fraction. This benefit extends beyond just preserving heart function, indicating broader positive effects.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Research
Background:
- Reperfusion therapy improves mortality in acute ST-segment elevation myocardial infarction (STEMI).
- Previous trials showed modest improvement in left ventricular ejection fraction (LVEF) despite significant mortality benefits.
Purpose of the Study:
- To compare 1-year mortality in STEMI survivors based on LVEF and reperfusion strategy.
- To investigate the impact of no early reperfusion, fibrinolysis, and primary percutaneous coronary intervention (PCI) on survival.
Main Methods:
- Prospective analysis of the MITRA-Plus registry.
- Inclusion of 5867 STEMI patients categorized by LVEF (preserved, moderately reduced, severely reduced).
- Comparison of outcomes for patients receiving no reperfusion, fibrinolysis, or primary PCI within 24 hours.
Main Results:
- Reperfusion therapy, including fibrinolysis and primary PCI, was independently associated with improved survival across all LVEF groups compared to no reperfusion.
- Primary PCI showed the strongest survival benefit, particularly in patients with severely reduced LVEF.
- Propensity score analysis adjusted for confounding variables.
Conclusions:
- Early reperfusion therapy offers survival benefits in STEMI patients beyond preserving left ventricular function.
- The precise mechanisms underlying this extended benefit require further investigation.
- Findings support the use of early reperfusion strategies in STEMI management.
Background:
Reperfusion therapy has been shown to improve mortality in patients with acute ST-segment elevation myocardial infarction. However, in randomized clinical trials there was only a modest improvement in left ventricular ejection fraction with reperfusion therapy, despite a larger improvement in mortality.
Methods:
In the prospective MITRA-Plus registry we compared 1-year mortality of inhospital survivors of ST-segment elevation myocardial infarction (STEMI) divided into nine groups with preserved (>55%), moderately reduced (41-55%) and severely reduced (≤40%) left ventricular ejection fraction (LVEF) and treated with no early reperfusion therapy, fibrinolysis or primary percutaneous coronary intervention (PCI) within 24 h after admission.
Results:
A total of 5867 patients were included in this analysis, 1026 (18%) without early reperfusion, 2462 (42%) with fibrinolysis and 2379 (40%) with primary PCI. After adjustment for confounding variables in a propensity score analysis, reperfusion therapy (Odds ratio and 95% CI: 0.27, 0.15-0.48; 0.50, 0.32-0.79; 0.64, 0.44-0.93), fibrinolysis (Odds ratio and 95% CI: 0.27, 0.14-0.52; 0.58, 0.35-0.95; 0.60, 0.39-0.93) and primary PCI (Odds ratio and 95% CI: 0.22, 0.11-0.44; 0.34, 0.19-0.59; 0.56, 0.36-0.88) remained independent predictors of survival in comparison to no reperfusion therapy in the patients with preserved, moderately reduced and severely reduced LVEF, respectively.
Conclusions:
These results suggest a beneficial effect of early reperfusion therapy beyond the preservation of left ventricular function, however the mechanisms need further study.
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