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Updated: Mar 7, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
The effects of remote ischemic conditioning in patients with ST-segment elevation myocardial infarction treated with
Jing Gao1,2,3, Qingjie Chen1,2, Fen Liu2
1Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
Insights
Remote ischemic conditioning (RIC) may protect the heart during ST-elevation myocardial infarction (STEMI) treatment. RIC reduced heart damage markers and improved ST resolution after primary percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Ischemia-Reperfusion Injury Research
Background:
- ST-elevation myocardial infarction (STEMI) requires timely reperfusion.
- Myocardial reperfusion injury can occur despite successful reperfusion.
- Remote ischemic conditioning (RIC) offers innate protection against ischemia-reperfusion injury.
Purpose of the Study:
- To assess the efficacy of RIC in STEMI patients undergoing primary percutaneous coronary intervention (PCI).
Main Methods:
- Systematic literature search of multiple databases up to December 2015.
- Included 9 trials with 540 patients in RIC groups and 533 in control groups.
- RIC involved intermittent limb ischemia cycles before, during, or after reperfusion; outcomes included CK-MB, ST resolution, and LVEF.
Main Results:
- RIC significantly reduced peak creatine kinase-MB (CK-MB) and CK-MB area under the curve (AUC) within 72 hours post-PCI.
- ST resolution (STR) was significantly improved in RIC patients compared to controls.
- Left ventricular ejection fraction (LVEF) improved at 7 days but not significantly different over 1 month.
Conclusions:
- RIC demonstrates a potential cardioprotective effect in acute STEMI patients treated with PCI.
- The timing of RIC (before, during, or after reperfusion) may influence outcomes.
Introduction:
Timely and successful reperfusion is effective at improving outcome in patients presenting with ST elevation myocardial infarction (STEMI). However, abrupt restoration of blood flow may cause detrimental myocardial reperfusion injury. Remote ischemic conditioning (RIC) is a potent activator of innate protection against ischemia-reperfusion injury. This study assessed remote ischemic conditioning in patients presenting with STEMI treated with primary percutaneous coronary intervention (PCI).
Evidence Acquisition:
Relevant studies were identified through electronic literature search from PubMed, Medline, EMBASE, CNKI, WANFANG, and VIP. Studies published up to December 2015 were eligible for inclusion. RIC was performed by applying consecutive cycles of reocclusion/reperfusion through intermittent upper or lower limb ischemia before, during, or after reperfusion. The outcomes included creatine kinase-MB (CK-MB), ST resolution (STR), and left ventricular ejection fraction (LVEF).
Evidence Synthesis:
The 9 trials allocated 540 patients to perform RIC cycles before, during, or after reperfusion and 533 patients to usual PCI. Statistical analysis indicated that the peak of CK-MB and CK-MB AUC in RIC groups decrease significantly during the first 72 hours after PCI compared with controls (P=0.02 and P<0.01). The STR was significantly improved in RIC patients than in control subjects (P<0.001). LVEF is also improved 7 days after myocardial infarction (P=0.001). However, LVEF was not significantly different between study groups over 1 month (P=0.65).
Conclusions:
There may be a cardioprotective effect of RIC before, during, or after reperfusion, in the setting of acute STEMI.
