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Updated: Apr 30, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Protection against myocardial ischemia-reperfusion injury in clinical practice
David Garcia-Dorado1, Antonio Rodríguez-Sinovas1, Marisol Ruiz-Meana1
1Hospital Universitario e Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Insights
Protecting against reperfusion injury in ST-segment elevation acute myocardial infarction is crucial. Further large-scale clinical trials are needed to establish effective protective strategies for improved patient survival and quality of life.
Area of Science:
- Cardiology
- Cellular Biology
- Biomedical Science
Background:
- ST-segment elevation acute myocardial infarction (STEMI) patients often experience poor outcomes despite early reperfusion therapy.
- Reperfusion injury contributes to cell death via calcium mishandling, oxidative stress, and mitochondrial dysfunction.
- Current protective strategies show inconsistent clinical results, highlighting a need for better approaches.
Purpose of the Study:
- To review current strategies for limiting infarct size in STEMI.
- To identify challenges and future directions for translating protective interventions into clinical practice.
Main Methods:
- Review of nonpharmacological strategies (ischemic postconditioning, remote ischemic conditioning).
- Review of pharmacological strategies (cyclosporine, GLP-1 agonists, beta-blockers, etc.).
- Analysis of factors contributing to clinical trial failures and recommendations for future research.
Main Results:
- Both nonpharmacological and pharmacological interventions have shown potential in limiting infarct size in preclinical studies.
- Clinical trial outcomes have been variable, often due to inconsistent data and suboptimal trial design (e.g., delayed administration).
- Factors like age, sex, and comorbidities influence treatment response and require consideration in trial design.
Conclusions:
- Translating cardioprotective strategies against reperfusion injury into standard STEMI treatment requires robust, large-scale clinical trials.
- Future trials must focus on primary clinical endpoints, combined therapies, and personalized approaches considering patient characteristics.
- Standardization of protective interventions is essential for improving survival and quality of life in STEMI patients.
Abstract:
Even when reperfusion therapy is applied as early as possible, survival and quality of life are compromised in a considerable number of patients with ST-segment elevation acute myocardial infarction. Some cell death following transient coronary occlusion occurs during reperfusion, due to poor handling of calcium in the sarcoplasmic reticulum-mitochondria system, calpain activation, oxidative stress, and mitochondrial failure, all promoted by rapid normalization of intracellular pH. Various clinical trials have shown that infarct size can be limited by nonpharmacological strategies--such as ischemic postconditioning and remote ischemic conditioning--or by drugs--such as cyclosporine, insulin, glucagon-like peptide-1 agonists, beta-blockers, or stimulation of cyclic guanosine monophosphate synthesis. However, some clinical studies have yielded negative results, largely due to a lack of consistent preclinical data or a poor design, especially delayed administration. Large-scale clinical trials are therefore necessary, particularly those with primary clinical variables and combined therapies that consider age, sex, and comorbidities, to convert protection against reperfusion injury into a standard treatment for patients with ST-segment elevation acute myocardial infarction.
