Impact of ischemic postconditioning with lactate-enriched blood on early inflammation after myocardial infarction

Possible creatine kinase washout mechanism revealed by postconditioning with lactate-enriched blood in patients experiencing ST-elevation myocardial infarctions

“…Furthermore, in 15 patients who returned for follow-up CAGs and had not experienced restenosis, intrapatient, corrected TIMI frame counts in the acute phase (20.7 ± 9.3 frames) were significantly smaller than those in the chronic phase (27.7 ± 8.5 frames, p = 0.0022). We previously reported that PCLeB induced excellent microcirculation recovery, in terms of angiography findings, i.e., marked myocardial staining by the contrast medium and/or its prompt venous drainage [3,4]. In this study, we confirmed this microcirculation recovery using a more quantitative approach.…”

“…We claimed that this biphasic relationship could not be explained by the traditional CK washout mechanism, but was explained after considering the significant contribution of cell death, caused by reperfusion injury, to early CK release [2]. Here, we report a negative correlation between the time to reperfusion and the time to peak CK release in 46 ST-elevation myocardial infarction (STEMI) patients treated using postconditioning with lactate-enriched blood (PCLeB) [3,4], providing additional clarity on the nature of the CK washout mechanism.We have treated 48 consecutive STEMI patients with primary PCI using our modified postconditioning protocol [3,4], within 12 h of onset, since 2011. Patients having an infarct-related coronary artery with a thrombolysis in myocardial infarction (TIMI) flow grade of II or III or having grade III collateral circulation were not included among the 48 STEMI patients.…”

“…We claimed that this biphasic relationship could not be explained by the traditional CK washout mechanism, but was explained after considering the significant contribution of cell death, caused by reperfusion injury, to early CK release [2]. Here, we report a negative correlation between the time to reperfusion and the time to peak CK release in 46 ST-elevation myocardial infarction (STEMI) patients treated using postconditioning with lactate-enriched blood (PCLeB) [3,4], providing additional clarity on the nature of the CK washout mechanism.…”

“…In 2 patients, we failed to recanalize the target coronary artery during the postconditioning procedures, and these patients were excluded from the study. According to our previously described protocol [3,4], the duration of each brief reperfusion was prolonged from 10 to 60 s, in a stepwise manner. At the end of each brief reperfusion, lactate was supplied by injecting lactated Ringer's solution (Lactec Injection, Otsuka Pharmaceutical, Tokyo, Japan), containing 28 mM lactate, into the culprit coronary artery (20 and 30 mL for the right and left coronary arteries, respectively).…”

“…We have treated 48 consecutive STEMI patients with primary PCI using our modified postconditioning protocol [3,4], within 12 h of onset, since 2011. Patients having an infarct-related coronary artery with a thrombolysis in myocardial infarction (TIMI) flow grade of II or III or having grade III collateral circulation were not included among the 48 STEMI patients.…”