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Updated: Jan 31, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
NHLBI-Sponsored Randomized Trial of Postconditioning During Primary Percutaneous Coronary Intervention for
Jay H Traverse1,2, Cory M Swingen2, Timothy D Henry1
1From the Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.H.T., T.D.H., J.F., Y.L.W., I.J.C., D.L.L., J.R.L., W.R.P., N.M.B., A.P., J.L.L., R.F.G.).
Insights
Postconditioning did not improve early outcomes in ST-segment-elevation myocardial infarction patients undergoing percutaneous coronary intervention. However, this intervention showed improved left ventricular remodeling at one year, particularly in patients with microvascular obstruction.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Research
Background:
- Postconditioning during primary percutaneous coronary intervention (PCI) for ST-segment-elevation myocardial infarction (STEMI) aims to reduce infarct size and improve myocardial salvage.
- Clinical trials have yielded inconsistent results regarding the benefits of postconditioning in STEMI patients.
Purpose of the Study:
- To evaluate the early and long-term effects of postconditioning on left ventricular (LV) function and remodeling in STEMI patients.
- To assess the impact of postconditioning in a rigorously selected STEMI population within a National Heart, Lung, and Blood Institute-sponsored trial.
Main Methods:
- A randomized trial involving 122 STEMI patients with occluded arteries and 1-6 hours of ischemia.
- Patients were assigned to either postconditioning (brief, repeated balloon inflations/deflations) plus PCI or routine PCI.
- Cardiac magnetic resonance imaging (CMR) was used to assess infarct size, myocardial salvage, LV ejection fraction, and remodeling at 2 days and 12 months post-PCI.
Main Results:
- No significant differences in infarct size, myocardial salvage index, or LV ejection fraction were observed at 2 days post-PCI between the postconditioning and control groups.
- Both groups showed significant recovery of LV ejection fraction by 12 months.
- Postconditioning was associated with more favorable LV remodeling and reduced microvascular obstruction at 1 year, especially in patients with baseline microvascular obstruction.
Conclusions:
- Postconditioning does not provide early benefits in terms of infarct size, myocardial salvage, or LV function in STEMI patients treated with primary PCI.
- However, postconditioning demonstrates a beneficial effect on long-term LV remodeling at 1 year, particularly for patients with microvascular obstruction.
Rationale:
Postconditioning at the time of primary percutaneous coronary intervention (PCI) for ST-segment-elevation myocardial infarction may reduce infarct size and improve myocardial salvage. However, clinical trials have shown inconsistent benefit.
Objective:
We performed the first National Heart, Lung, and Blood Institute-sponsored trial of postconditioning in the United States using strict enrollment criteria to optimize the early benefits of postconditioning and assess its long-term effects on left ventricular (LV) function.
Methods And Results:
We randomized 122 ST-segment-elevation myocardial infarction patients to postconditioning (4, 30 seconds PTCA [percutaneous transluminal coronary angioplasty] inflations/deflations)+PCI (n=65) versus routine PCI (n=57). All subjects had an occluded major epicardial artery (thrombolysis in myocardial infarction=0) with ischemic times between 1 and 6 hours with no evidence of preinfarction angina or collateral blood flow. Cardiac magnetic resonance imaging measured at 2 days post-PCI showed no difference between the postconditioning group and control in regards to infarct size (22.5±14.5 versus 24.0±18.5 g), myocardial salvage index (30.3±15.6% versus 31.5±23.6%), or mean LV ejection fraction. Magnetic resonance imaging at 12 months showed a significant recovery of LV ejection fraction in both groups (61.0±11.4% and 61.4±9.1%; P<0.01). Subjects randomized to postconditioning experienced more favorable remodeling over 1 year (LV end-diastolic volume =157±34 to 150±38 mL) compared with the control group (157±40 to 165±45 mL; P<0.03) and reduced microvascular obstruction ( P=0.05) on baseline magnetic resonance imaging and significantly less adverse LV remodeling compared with control subjects with microvascular obstruction ( P<0.05). No significant adverse events were associated with the postconditioning protocol and all patients but one (hemorrhagic stroke) survived through 1 year of follow-up.
Conclusions:
We found no early benefit of postconditioning on infarct size, myocardial salvage index, and LV function compared with routine PCI. However, postconditioning was associated with improved LV remodeling at 1 year of follow-up, especially in subjects with microvascular obstruction.
Clinical Trial Registration:
URL: http://www.clinicaltrials.gov . Unique identifier: NCT01324453.
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