Ischemic Postconditioning with Lactate-Enriched Blood in Patients with Acute Myocardial Infarction

Postconditioning with Lactate-Enriched Blood in Patients with ST-Segment Elevation Myocardial Infarction

“…My colleagues and I recently reported a new approach for cardioprotection in patients with STEMI, namely postconditioning with lactate-enriched blood (PCLeB) [4-6]. Our modified postconditioning protocol consists of intermittent reperfusion and timely coronary injections of lactated Ringer’s solution, aimed at achieving controlled reperfusion with tissue oxygenation and minimal lactate washout (Fig.…”

Acidic Postconditioning in ST-Elevation Myocardial Infarction Patients

“…In this issue of Cardiology , Koyama et al [10 ]present a new approach to reduce reperfusion injury. Starting from the assumption that a proposed mechanism of PC cardioprotection is due to the delayed recovery from intracellular acidosis during the early stages of reperfusion, in a series of 6 patients, they courageously tested an original PC protocol with gradually increasing reperfusion intervals and by administrating intracoronary lactated Ringer's solution in the occlusion periods.…”

“…In this complex scenario, it is acknowledged that many potential confounding factors, such as left-ventricle hypertrophy, diabetes mellitus, chronic kidney disease, microvascular disease or several drugs, may influence reperfusion injury and PC cardioprotective mechanisms, making a translation from bench to bedside even more difficult [11]. The protocol proposed by Koyama et al [10] addresses one issue, the better preservation of an acidic status in cardiomyocytes, but leaves many other important aspects of PC largely unaltered.…”

What Is the Optimal Cardioprotective Treatment of Reperfusion Injury?

“…In this issue of Cardiology, Koyama et al [11] propose an altered postconditioning protocol using a modified reperfusion-occlusion algorithm with gradually increasing reperfusion duration from 10 to 60 s over 7 cycles, combined with intracoronary injection of lactated Ringer's solution. The rationale for this approach is based on experimental data.…”

“…In their small pilot study of 6 STEMI patients, Koyama et al [11] report no adverse events associated with the modified postconditioning procedure. It is unclear to what degree the dose of lactate and/or the modified cycle lengths will affect intracellular pH in this setting.…”