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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
Renoprotective effect of remote ischemic postconditioning in patients with ST-elevation myocardial infarction
Bangming Cao1, Chi Zhang1, Haipeng Wang1
1Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.
Insights
Remote ischemic postconditioning (RIPostC) of the upper arm protected kidneys and heart in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). RIPostC reduced acute kidney injury and improved cardiac function post-PPCI.
Area of Science:
- Cardiology
- Nephrology
- Ischemia-Reperfusion Injury
Background:
- ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI) are at risk of kidney injury.
- The protective effects of upper arm remote ischemic postconditioning (RIPostC) on kidney function in this population are not well understood.
Purpose of the Study:
- To investigate the efficacy of upper arm RIPostC in protecting renal function in STEMI patients during PPCI.
- To evaluate the impact of RIPostC on cardiac function and myocardial injury markers post-PPCI.
Main Methods:
- A randomized controlled trial involving 64 STEMI patients undergoing PPCI.
- Patients were assigned to either PPCI + RIPostC or PPCI alone.
- RIPostC involved 4 cycles of 5-minute upper arm occlusion/reperfusion. Serum creatinine, CK-MB, and eGFR were monitored. Left ventricular ejection fraction (LVEF) was assessed via echocardiography.
Main Results:
- The RIPostC group showed a significantly lower acute kidney injury (AKI) rate (P=0.04).
- Estimated glomerular filtration rate (eGFR) increased post-PPCI in the RIPostC group (P<0.01).
- RIPostC led to lower peak CK-MB levels (P<0.01), reduced CK-MB area under the curve, and higher LVEF (P=0.04) compared to the control group.
Conclusions:
- Upper arm RIPostC provides significant renal protection against AKI in STEMI patients undergoing PPCI.
- RIPostC also demonstrates cardiac benefits, reducing myocardial injury and improving LVEF post-reperfusion.
Background:
Whether upper arm remote ischemic postconditioning (RIPostC) exerts protection to kidney in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) remains unknown.
Methods:
Sixty-four patients with STEMI were randomized to PPCI + RIPostC (n=29) and PPCI (n=35) groups. RIPostC consisting of 4 cycles of 5 minutes occlusion/reperfusion by cuff inflation/deflation of the upper arm was started within 1 minute after the first balloon dilatation. Peripheral venous blood samples were collected before PPCI and at 0.5, 8, 24, 48, and 72 hours after PPCI to detect serum creatinine (SCr) and creatine kinase-MB (CK-MB). Acute kidney injury (AKI) rate and estimated glomerular filtration rate (eGFR) were calculated. The transthoracic echocardiography was performed 7 days after PPCI to assess left ventricular ejection fraction (LVEF).
Results:
The patients in the PPCI + RIPostC group had a lower AKI rate compared with those in the PPCI group (P=0.04). The eGFR after PPCI increased in the PPCI + RIPostC group compared to the PPCI group (P<0.01). The peak of CK-MB concentration in the PPCI + RIPostC group was significantly lower than that in the PPCI group (P<0.01). The area under the curve of CK-MB decreased in the PPCI + RIPostC group compared with that in the PPCI group. LVEF in the PPCI + RIPostC group was significantly higher than that in the PPCI group (P=0.04).
Conclusion:
Upper arm RIPostC exerts renal and cardiac protection following cardiac ischemia-reperfusion in patients with STEMI.
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