'Postconditioning' the human heart: multiple balloon inflations during primary angioplasty may confer cardioprotection

• Published in: Basic research in cardiology Vol. 102; no. 3; pp. 274 - 278
• Main Authors: Darling, Chad E, Solari, Patrick B, Smith, Craig S, Furman, Mark I, Przyklenk, Karin
• Format: Journal Article
• Language: English
• Published: Germany Springer Nature B.V 01-05-2007
• Subjects: Angioplasty, Balloon, Coronary - methods; Creatine Kinase - blood; Electrocardiography; Female; Heart Conduction System; Humans; Ischemic Preconditioning, Myocardial - methods; Male; Middle Aged; Myocardial Infarction - blood; Myocardial Infarction - therapy; Retrospective Studies
• ISSN: 0300-8428; 1435-1803
• DOI: 10.1007/s00395-007-0643-6

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.