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Updated: Jun 17, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Effect of supersaturated oxygen delivery on infarct size after percutaneous coronary intervention in acute myocardial
Gregg W Stone1, Jack L Martin, Menko-Jan de Boer
1Columbia University Medical Center, New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY 10022, USA. gs2184@columbia.edu
Insights
Supersaturated oxygen (SSO(2)) infusion significantly reduced infarct size in ST-segment elevation myocardial infarction patients undergoing percutaneous coronary intervention. This treatment demonstrated noninferior safety outcomes at 30 days.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- Myocardial salvage after percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) is often suboptimal.
- Previous studies suggested intracoronary supersaturated oxygen (SSO(2)) may reduce infarct size in STEMI patients.
Purpose of the Study:
- To evaluate the efficacy and safety of intracoronary SSO(2) infusion in reducing infarct size in STEMI patients undergoing PCI.
- To assess major adverse cardiovascular events (MACE) at 30 days post-procedure.
Main Methods:
- A prospective, multicenter trial randomized 301 STEMI patients to 90-minute intracoronary SSO(2) infusion or control.
- Primary efficacy endpoint: infarct size; Primary safety endpoint: MACE at 30 days.
- Bayesian hierarchical modeling was used for pooled analysis with a prior trial (AMIHOT I).
Main Results:
- Median infarct size was reduced in the SSO(2) group (20% vs. 26.5% in control) in the intention-to-treat population.
- Pooled adjusted infarct size showed a significant reduction with SSO(2) (18.5% vs. 25% for control; P=0.02).
- Bayesian analysis indicated a 96.9% probability of SSO(2) superiority in reducing infarct size and high probability of noninferiority for MACE.
Conclusions:
- Intracoronary SSO(2) infusion significantly reduces infarct size in anterior STEMI patients undergoing PCI within 6 hours of symptom onset.
- The treatment demonstrated noninferior rates of major adverse cardiovascular events at 30 days.
- SSO(2) represents a promising therapeutic approach for improving myocardial salvage in STEMI.
Background:
Myocardial salvage is often suboptimal after percutaneous coronary intervention in ST-segment elevation myocardial infarction. Posthoc subgroup analysis from a previous trial (AMIHOT I) suggested that intracoronary delivery of supersaturated oxygen (SSO(2)) may reduce infarct size in patients with large ST-segment elevation myocardial infarction treated early.
Methods And Results:
A prospective, multicenter trial was performed in which 301 patients with anterior ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention within 6 hours of symptom onset were randomized to a 90-minute intracoronary SSO(2) infusion in the left anterior descending artery infarct territory (n=222) or control (n=79). The primary efficacy measure was infarct size in the intention-to-treat population (powered for superiority), and the primary safety measure was composite major adverse cardiovascular events at 30 days in the intention-to-treat and per-protocol populations (powered for noninferiority), with Bayesian hierarchical modeling used to allow partial pooling of evidence from AMIHOT I. Among 281 randomized patients with tc-99m-sestamibi single-photon emission computed tomography data in AMIHOT II, median (interquartile range) infarct size was 26.5% (8.5%, 44%) with control compared with 20% (6%, 37%) after SSO(2). The pooled adjusted infarct size was 25% (7%, 42%) with control compared with 18.5% (3.5%, 34.5%) after SSO(2) (P(Wilcoxon)=0.02; Bayesian posterior probability of superiority, 96.9%). The Bayesian pooled 30-day mean (+/-SE) rates of major adverse cardiovascular events were 5.0+/-1.4% for control and 5.9+/-1.4% for SSO(2) by intention-to-treat, and 5.1+/-1.5% for control and 4.7+/-1.5% for SSO(2) by per-protocol analysis (posterior probability of noninferiority, 99.5% and 99.9%, respectively).
Conclusions:
Among patients with anterior ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention within 6 hours of symptom onset, infusion of SSO(2) into the left anterior descending artery infarct territory results in a significant reduction in infarct size with noninferior rates of major adverse cardiovascular events at 30 days. Clinical Trial Registration- clinicaltrials.gov Identifier: NCT00175058.
