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Updated: Jun 7, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Effect of postconditioning on infarct size in patients with ST elevation myocardial infarction
Peder Sörensson1, Nawzad Saleh, Frederic Bouvier
1Karolinska University Hospital, 171 76 Stockholm, Sweden. peder.sorensson@karolinska.se
Insights
Postconditioning reperfusion therapy did not reduce overall infarct size in ST-elevation myocardial infarction (STEMI) patients. However, it significantly reduced infarct size in patients with large areas at risk, suggesting a potential benefit for this subgroup.
Area of Science:
- Cardiology
- Interventional Cardiology
- Myocardial Infarction Research
Background:
- Limited studies suggest postconditioning may protect the myocardium.
- This technique involves interrupting reperfusion with brief reocclusions.
Purpose of the Study:
- To evaluate if postconditioning limits infarct size relative to the area at risk in ST-elevation myocardial infarction (STEMI) patients.
- To test the efficacy of postconditioning in reducing myocardial damage post-STEMI.
Main Methods:
- A randomized trial involving 76 STEMI patients undergoing primary percutaneous coronary intervention.
- Patients were assigned to either standard percutaneous coronary intervention or postconditioning (intermittent reocclusion before reperfusion).
- Infarct size was assessed using delayed enhancement MRI; area at risk was determined angiographically.
Main Results:
- Overall infarct size relative to the area at risk did not differ significantly between postconditioning and control groups.
- Postconditioning significantly reduced infarct size in patients with large areas at risk (p=0.001).
- Biomarkers of myocardial injury (troponin T, CKMB) did not differ between groups.
Conclusions:
- Postconditioning does not reduce overall infarct size in STEMI patients.
- The findings suggest postconditioning may be beneficial for STEMI patients with large areas at risk.
- Further research is warranted to explore the specific benefits in patient subgroups.
Background:
Small studies suggest that postconditioning reperfusion interrupted by brief repetitive cycles of reocclusions, may protect the myocardium in the clinical setting.
Objective:
To test the hypothesis that postconditioning limits infarct size in relation to the area at risk in patients with ST elevation myocardial infarction (STEMI).
Methods:
76 patients (aged 37-87 years) eligible for primary percutaneous coronary intervention due to STEMI were randomised to standard percutaneous coronary intervention (n = 38) or postconditioning, consisting of four cycles of 60 s reperfusion and 60 s of reocclusion before permanent reperfusion (n = 38).
Results:
The area at risk was determined from angiographic abnormally contracting segments. Infarct size was quantified from delayed enhancement MRI on days 6-9. Infarct size, expressed in relation to the area at risk, did not differ between the control group (44%; 30, 56) (median and quartiles) and the post-conditioned group (47%; 23, 63). The slope of the regression lines relating infarct size to the area at risk differed between the two groups. Infarct size was significantly (p = 0.001) reduced by postconditioning in patients with large areas at risk. The area under the curve and peak troponin T release and CKMB during 48 h did not differ between patients in the control and postconditioning groups.
Conclusions:
This prospective, randomised trial suggests that postconditioning does not reduce infarct size in patients with STEMI in the overall study group. The data indicate that postconditioning may be of value in patients with large areas at risk. Clinical trial registration information Karolinska Clinical Trial Registration (http://www.kctr.se). Unique identifier: CT20080014.
