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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Different postconditioning cycles affect prognosis of aged patients undergoing primary percutaneous coronary
Jie Zhang, Xin Zhang, Yuqi Cui
1Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong University, 324 Jingwuweiqi road, 250021 jinan, China. pengalfie@163.com.
Insights
Postconditioning improves prognosis in aged patients with acute myocardial infarction (AMI). A 4-cycle, 60-second protocol showed cardiac protective benefits in wall motion and SPECT imaging.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- Acute myocardial infarction (AMI) poses significant risks for aged patients.
- Postconditioning is a potential therapeutic strategy to mitigate myocardial damage.
- Limited research exists on optimal postconditioning protocols for elderly AMI patients undergoing primary percutaneous coronary intervention (PCI).
Purpose of the Study:
- To evaluate the impact of different postconditioning cycles on the prognosis of aged patients with AMI.
- To compare the efficacy of two distinct postconditioning protocols (PC-1 and PC-2) against a control group following primary PCI.
Main Methods:
- Seventy-four elderly AMI patients were randomized into control, PC-1 (4x30s cycles), and PC-2 (4x60s cycles) groups.
- Biomarkers (CK-MB, cTnI, hs-CRP) and corrected Thrombolysis in Myocardial Infarction (cTIMI) frame counts were measured.
- Echocardiography and single-photon emission computed tomography (SPECT) assessed cardiac function, wall motion score index (WMSI), and infarct size at 7 days and 6 months post-PCI.
Main Results:
- Postconditioning significantly reduced peak CK-MB, 72h cTnI, and cTIMI frame counts compared to the control group.
- Postconditioning lowered hs-CRP levels at 24 hours post-procedure.
- While both PC-1 and PC-2 showed benefits, the 60s protocol (PC-2) demonstrated superior improvement in WMSI and SPECT scores at 6 months.
Conclusions:
- Postconditioning offers significant prognostic benefits for aged patients with AMI.
- A 4-cycle, 60-second postconditioning protocol demonstrates a notable cardiac protective effect, particularly on WMSI and SPECT.
- This 60-second protocol is recommended for clinical implementation in elderly AMI patients.
Background:
Postconditioning can affect the infarct size in acute myocardial infarction (AMI). How-ever, few studies show an effect of different postconditioning cycles on AMI aged patients. This study sought to assess the effect of different postconditioning cycles on prognosis in aged patients with AMI who underwent primary percutaneous coronary intervention (PCI).
Methods:
Seventy four aged patients were randomly assigned to three groups. Control group; PC-1 group accepted postconditioning 4 cycles of 30 s inflation and 30 s deflation; PC-2 group accepted postconditioning 4 cycles of 60 s. Creatine kinase MB (CK-MB), troponin I (cTnI), high-sensitive C-reactive protein (hs-CRP) and corrected Thrombolysis in Myocardial Infarction (TIMI) frame counts (CTFC) were analyzed before and after treatment. All patients received an echocardiographic examina-tion for whole heart function, wall motion score index (WMSI) and single-photon emission computed tomography (SPECT) examination at 7 days and 6 months after treatment.
Results:
The peak of CK-MB, postoperative 72 h cTnI and CTFC were significantly attenuated by postconditioning when compared with the control group. The hs-CRP of the postconditioning group was lower than the control group 24 h postoperative. No difference was observed between PC-1 and PC-2 group about the effect described above. At 7 days, heart function in the postconditioning group was im-proved when compared with the control group. At 6 months, the WMSI and SPECT score significantly reduced in the PC-2 group compared with the control and PC-1 groups, but there was no difference among the three groups about echo data except the left ventricular end-systolic diameter.
Conclusions:
Postconditioning is significantly beneficial to prognosis in aged patients with AMI. The cardiac protective effect of 4 cycles of 60 s procedure was observed in WMSI and SPECT. It is favorable to implement this procedure in aged patients with AMI in clinic.
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