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Updated: Feb 13, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Meta-analysis of the effects of ischemic postconditioning on structural pathology in ST-segment elevation acute
Baohui Lou1, Yadong Cui1,2, Haiyang Gao3
1Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China.
Insights
Local and remote ischemic postconditioning (LPoC and RPoC) improve myocardial salvage and reduce edema in ST-segment elevation acute myocardial infarction (STEMI) patients. However, these methods do not impact final infarct size or left ventricular volume.
Area of Science:
- Cardiology
- Cardiovascular Research
- Interventional Cardiology
Background:
- ST-segment elevation acute myocardial infarction (STEMI) is a critical condition requiring timely reperfusion.
- Ischemic postconditioning, both local (LPoC) and remote (RPoC), has emerged as a potential cardioprotective strategy.
- Assessing the impact of LPoC and RPoC on myocardial structural pathology in STEMI is crucial for clinical practice.
Purpose of the Study:
- To evaluate the effects of local and remote ischemic postconditioning on cardiac structural pathology in STEMI patients.
- To synthesize evidence from randomized controlled trials using cardiac magnetic resonance imaging (CMR) data.
- To determine if LPoC and RPoC influence myocardial salvage, edema, infarct size, and microvascular obstruction.
Main Methods:
- A meta-analysis of 12 randomized controlled trials (RCTs) involving 1069 STEMI patients with TIMI flow grade 0-1.
- Searched PubMed, Embase, and Cochrane Library databases up to May 2017.
- Pooled analysis using weighted mean difference (WMD), standardized mean difference (SMD), and odds ratio (OR) with a random-effect model.
Main Results:
- LPoC and RPoC significantly increased myocardial salvage index (WMD = 5.52, P = 0.005) and decreased myocardial edema (WMD = -3.35, P = 0.0009).
- No significant reduction was observed in final infarct size (WMD = -1.01, P > 0.05), left ventricular volume (SMD = 0.23, P > 0.05), or microvascular obstruction (incidence OR = 0.99, P > 0.05; extent WMD = -0.09, P > 0.05).
- High heterogeneity (I² > 68%) was noted for infarct size and left ventricular volume outcomes.
Conclusions:
- Local and remote ischemic postconditioning demonstrate cardioprotective effects by improving myocardial salvage and reducing edema in STEMI.
- These interventions do not significantly alter final infarct size, left ventricular remodeling, or microvascular obstruction.
- Further research may be needed to optimize LPoC and RPoC strategies for STEMI management.
Abstract:
In this meta-analysis, we assessed cardiac magnetic resonance imaging data to determine the effects of local and remote ischemic postconditioning (LPoC and RPoC, respectively) on structural pathology in ST-segmentel elevation acute myocardial infarction (STEMI). We searched the Pubmed, Embase and Cochrane Library databases up to May 2017 and included 12 randomized controlled trials (10 LPoC and 2 RPoC)containing 1069 study subjects with thrombolysis in myocardial infarction flow grade 0~1. Weighed mean difference (WMD), standardized mean difference (SMD), and odds ratio (OR) were used for the pooled analysis. Random-effect model was used for the potential clinical inconsistency. LPoC and RPoC increased the myocardial salvage index (n = 5; weighted mean difference (WMD) = 5.52; P = 0.005; I2 = 76.0%), and decreased myocardial edema (n = 7; WMD = -3.35; P = 0.0009; I2 = 18.0%). However, LPoC and RPoC did not reduce the final infarct size (n = 10; WMD = -1.01; P > 0.05; I2 = 68.0%), left ventricular volume (n = 10; standardized mean difference = 0.23; P > 0.05; I2 = 93.0%), the incidence of microvascular obstruction (n = 6; OR = 0.99; P > 0.05; I2 = 0.0%) or the extent of microvascular obstruction (n = 3; WMD = -0.09; P > 0.05; I2 = 6.0%). This meta-analysis shows that LPoC and/or RPoC improves myocardial salvage and decreases myocardial edema in STEMI patients without affecting final infarct size, left ventricular volume or microvascular obstruction.
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