'Postconditioning' the human heart: multiple balloon inflations during primary angioplasty may confer cardioprotection.
Growing evidence from experimental models suggests that relief of myocardial ischemia in a stuttering manner (i.e., 'postconditioning' [PostC] with brief cycles of reperfusion-reocclusion) limits infarct size. However, the potential clinical efficacy of PostC has, to date,been largely unexplored. Using a retrospective study design, our aim was to test the hypothesis that creatine kinase release (CK: clinical surrogate of infarct size) would be attenuated in ST-segment elevation myocardial infarction (STEMI) patients requiring multiple balloon inflations-deflations during primary angioplasty versus STEMI patients who received minimal balloon inflations and/or direct stenting. To investigate this concept, we reviewed the records of all STEMI patients with single vessel occlusion who presented to our institution from November 2004 - April 2006 for primary angioplasty. Exclusion criteria were: previous MI, cardiogenic shock, patients resuscitated from cardiac arrest, or pre-infarct angina. Patients were prospectively divided into two subsets: those receiving 1-3 balloon inflations (considered the minimum range to achieve patency and stent placement) versus those in whom 4 or more inflations were applied. Peak CK release was significantly lower in patients requiring > or =4 versus 1-3 inflations (1655 versus 2272 IU/L; p<0.05), an outcome consistent with the concept that relief of sustained ischemia in a stuttered manner (analogous to postconditioning) may evoke cardioprotection in the clinical setting.
Darling
Chad E
CE
Dept. of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue, North Worcester , MA, 01655, USA.
Solari
Patrick B
PB
Smith
Craig S
CS
Furman
Mark I
MI
Przyklenk
Karin
K
D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D003402:Creatine Kinase / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000628:therapy*; D012189:Retrospective Studies
D003402:Creatine Kinase