Postconditioning the human heart

• Published in: Circulation (New York, N.Y.) Vol. 112; no. 14; pp. 2143 - 2148
• Main Authors: STAAT, Patrick, RIOUFOL, Gilles, OVIZE, Michel, PIOT, Christophe, COTTIN, Yves, CUNG, Thien Tri, L'HUILLIER, Isabelle, AUPETIT, Jean-Francois, BONNEFOY, Eric, FINET, Gérard, ANDRE-FOUET, Xavier
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 04.10.2005
• Subjects: Adult; Angioplasty, Balloon, Coronary; Biological and medical sciences; Blood and lymphatic vessels; Blood vessels and receptors; Cardiology. Vascular system; Cardiovascular system; Coronary Angiography; Coronary Vessels - pathology; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Electrocardiography; Female; Fundamental and applied biological sciences. Psychology; Humans; Hypertension - epidemiology; Ischemic Preconditioning, Myocardial; Male; Medical sciences; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - therapy; Patient Selection; Pharmacology. Drug treatments; Reperfusion Injury - diagnostic imaging; Reperfusion Injury - prevention & control; Risk Factors; Smoking; Vasodilator agents. Cerebral vasodilators; Vertebrates: cardiovascular system; Human; Myocardial infarction; postconditioning; Reperfusion; Ischemia; Heart disease; Cardiovascular disease; Myocardial disease
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circulationaha.105.558122

In animal models, brief periods of ischemia performed just at the time of reperfusion can reduce infarct size, a phenomenon called postconditioning. In this prospective, randomized, controlled, multicenter study, we investigated whether postconditioning may protect the human heart during coronary angioplasty for acute myocardial infarction. Thirty patients, submitted to coronary angioplasty for ongoing acute myocardial infarction, contributed to the study. Patients were randomly assigned to either a control or a postconditioning group. After reperfusion by direct stenting, control subjects underwent no further intervention, whereas postconditioning was performed within 1 minute of reflow by 4 episodes of 1-minute inflation and 1-minute deflation of the angioplasty balloon. Infarct size was assessed by measuring total creatine kinase release over 72 hours. Area at risk and collateral blood flow were estimated on left ventricular and coronary angiograms. No adverse events occurred in the postconditioning group. Determinants of infarct size, including ischemia time, size of the area at risk, and collateral flow, were comparable between the 2 groups. Area under the curve of creatine kinase release was significantly reduced in the postconditioning compared with the control group, averaging 208 984+/-26 576 compared with 326,095+/-48,779 (arbitrary units) in control subjects, ie, a 36% reduction in infarct size. Blush grade, a marker of myocardial reperfusion, was significantly increased in postconditioned compared with control subjects: 2.44+/-0.17 versus 1.95+/-0.27, respectively (P<0.05). This study suggests that postconditioning by coronary angioplasty protects the human heart during acute myocardial infarction.