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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Post-conditioning reduces infarct size and edema in patients with ST-segment elevation myocardial infarction
Franck Thuny1, Olivier Lairez, François Roubille
1CREATIS, CNRS UMR 5220, INSERM U1044, Université de Lyon, Lyon, France. franck.thuny@gmail.com
Insights
Post-conditioning significantly reduced myocardial edema and infarct size in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention. This cardioprotective strategy lessens reperfusion injury in STEMI patients.
Area of Science:
- Cardiology
- Cardiovascular Research
- Interventional Cardiology
Background:
- Myocardial edema is a critical reperfusion injury following acute myocardial infarction.
- Post-conditioning is a known cardioprotective strategy that limits infarct size.
- Its effect on reperfusion-induced myocardial edema in humans has not been previously studied.
Purpose of the Study:
- To investigate the efficacy of post-conditioning in mitigating reperfusion-induced myocardial edema.
- To assess the impact of post-conditioning on infarct size in ST-segment elevation myocardial infarction (STEMI) patients.
Main Methods:
- A randomized controlled trial involving 50 STEMI patients undergoing percutaneous coronary intervention.
- Cardiac magnetic resonance imaging (MRI) with T2-weighted and late gadolinium enhancement sequences was used.
- Myocardial edema and infarct size were quantified using MRI, alongside creatine kinase measurements.
Main Results:
- Post-conditioning was associated with significantly smaller infarct size (13 ± 7 g/m² vs. 21 ± 14 g/m²; p = 0.01).
- Myocardial edema was significantly reduced in the post-conditioned group (23 ± 16 g/m² vs. 34 ± 18 g/m²; p = 0.03).
- Peak serum creatine kinase levels were also lower in the post-conditioned group (p = 0.003).
Conclusions:
- Post-conditioning effectively reduces infarct size in reperfused STEMI patients.
- This strategy also significantly decreases reperfusion-induced myocardial edema.
- Post-conditioning represents a promising therapeutic approach for limiting myocardial damage in STEMI.
Objectives:
This study aimed to determine whether post-conditioning at the time of percutaneous coronary intervention could reduce reperfusion-induced myocardial edema in patients with acute ST-segment elevation myocardial infarction (STEMI).
Background:
Myocardial edema is a reperfusion injury with potentially severe consequences. Post-conditioning is a cardioprotective therapy that reduces infarct size after reperfusion, but no previous studies have analyzed the impact of this strategy on reperfusion-induced myocardial edema in humans.
Methods:
Fifty patients with STEMI were randomly assigned to either a control or post-conditioned group. Cardiac magnetic resonance imaging was performed within 48 to 72 h after admission. Myocardial edema was measured by T2-weighted sequences, and infarct size was determined by late gadolinium enhancement sequences and creatine kinase release.
Results:
The post-conditioned and control groups were similar with respect to ischemia time, the size of the area at risk, and the ejection fraction before percutaneous coronary intervention. As expected, post-conditioning was associated with smaller infarct size (13 ± 7 g/m(2) vs. 21 ± 14 g/m(2); p = 0.01) and creatine kinase peak serum level (median [interquartile range]: 1,695 [1,118 to 3,692] IU/l vs. 3,505 [2,307 to 4,929] IU/l; p = 0.003). At reperfusion, the extent of myocardial edema was significantly reduced in the post-conditioned group as compared with the control group (23 ± 16 g/m(2) vs. 34 ± 18 g/m(2); p = 0.03); the relative increase in T2W signal intensity was also significantly lower (p = 0.02). This protective effect was confirmed after adjustment for the size of the area at risk.
Conclusions:
This randomized study demonstrated that post-conditioning reduced infarct size and edema in patients with reperfused STEMI.
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