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Updated: Nov 6, 2025
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Intra-Coronary Administration of Tacrolimus Improves Myocardial Perfusion and Left Ventricular Function in Patients
Pei-Hsun Sung1,2,3, Wei-Chun Huang4, Ting-Hsing Chao5
1Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine.
Insights
Intracoronary tacrolimus improved microcirculation and heart function in ST-segment elevation myocardial infarction (STEMI) patients. Further research is needed to confirm its impact on long-term clinical outcomes.
Area of Science:
- Cardiology
- Immunology
- Pharmacology
Background:
- Ischemia-reperfusion injury in ST-segment elevation myocardial infarction (STEMI) is linked to inflammation.
- The efficacy of intracoronary (IC) tacrolimus in improving myocardial perfusion post-STEMI is not well-established.
Purpose of the Study:
- To evaluate the effect of IC tacrolimus on myocardial perfusion and clinical outcomes in STEMI patients undergoing primary percutaneous coronary intervention (PCI).
Main Methods:
- A multicenter, double-blind, randomized controlled trial involving 316 STEMI patients.
- Patients received either IC tacrolimus (n=151) or placebo (n=165) before first balloon inflation during primary PCI.
- Primary endpoints included post-PCI TIMI-3 flow and a composite of TIMI-3 flow, TIMI myocardial perfusion (TMP) grade, and 90-min ST-segment resolution (STR). Secondary endpoints included left ventricular ejection fraction (LVEF) and major adverse cardio-cerebral vascular events (MACCEs).
Main Results:
- While epicardial flow and MACCE rates did not differ, the tacrolimus group showed significantly higher TMP grade and 90-min STR.
- Patients treated with tacrolimus exhibited improved 3D LVEF and reduced left ventricular diastolic dysfunction at 9 months.
- No significant difference in 1-month or 1-year MACCE rates was observed between groups.
Conclusions:
- IC tacrolimus administration in STEMI patients enhances coronary microcirculation and improves left ventricular systolic and diastolic function at 9 months.
- The study suggests a potential benefit of IC tacrolimus on myocardial recovery post-STEMI.
- Clinical outcome benefits remain inconclusive due to limited patient enrollment, necessitating further investigation.
Background:
Ischemia-reperfusion injury following acute ST-segment elevation myocardial infarction (STEMI) is strongly related to inflammation. However, whether intracoronary (IC) tacrolimus, an immunosuppressant, can improve myocardial perfusion is uncertain.
Methods:
A multicenter double-blind randomized controlled trial was conducted in Taiwan from 2014 to 2017. Among 316 STEMI patients with Killip class ≤ 3 undergoing primary percutaneous coronary intervention (PCI), 151 were assigned to the study group treated with IC tacrolimus 2.5 mg to the culprit vessel before first balloon inflation, and the remaining 165 were assigned to the placebo group receiving IC saline only. The primary endpoint was percentage of post-PCI TIMI-3 flow. The primary composite endpoints included achievement of TIMI-3 flow, TIMI- myocardial perfusion (TMP) grade, or 90-min ST-segment resolution (STR). The secondary endpoints were left ventricular ejection fraction (LVEF) and 1-month/1-year major adverse cardio-cerebral vascular events (MACCEs) (defined as death, myocardial infarction, stroke, target-vessel revascularization or re-hospitalization for heart failure).
Results:
Although post-PCI TIMI-3 epicardial flow and MACCE rate at 1 month and 1 year did not differ between the two groups, TMP grade (2.54 vs. 2.23, p < 0.001) and 90-min STR (67% vs. 61%, p < 0.001) were significantly higher in the tacrolimus-treated group than in the placebo group. The STEMI patients treated with tacrolimus also had significantly higher 3D LVEF and less grade 2 or 3 LV diastolic dysfunction at 9 months compared to those without.
Conclusions:
IC tacrolimus for STEMI improved coronary microcirculation and 9-month LV systolic and diastolic functions. However, the benefit of tacrolimus on clinical outcomes remains inconclusive due to insufficient patient enrollment.
