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

Lactated Ringer's solution for preventing myocardial reperfusion injury

“…Mechanical restoration of coronary blood flow by percutaneous coronary intervention (PCI) often results in tissue hypoperfusion in patients with STEMI; this is reperfusion injury in the microvasculature, known as the no-reflow phenomenon [25] , [26] , or more recently as microvascular obstruction [27] , [28] . My colleagues and I reported that PCLeB was consistently followed by angiographically excellent microcirculation recovery [2] , [3] , [4] , [5] , [6] . The coronary angiography findings of a representative patient are presented in Fig.…”

“…Although infarct-size reduction would be the most robust evidence for the successful prevention of lethal reperfusion injury, this has not yet been demonstrated in patients treated using PCLeB. However, my colleagues and I recently demonstrated that PCLeB abolished a biphasic relationship between the time to reperfusion and the time to peak creatine kinase (CK) release, which might be attributed to the consequences of lethal reperfusion injury [4] .…”

“…My colleagues and I recently reported a new modified postconditioning protocol, postconditioning with lactate-enriched blood (PCLeB), which appeared to be effective against all four types of reperfusion injury [2] , [3] , [4] , [5] , [6] . In this review article, I discuss a possible mechanism of reperfusion injury, which we believe to be valid and which we targeted using the new postconditioning protocol, and I report how this new approach worked in preventing each type of reperfusion injury.…”

An extensive discrepancy in myocardial uptake of thallium-201 and iodine-123 BMIPP in a patient with ST-segment elevation myocardial infarction treated using postconditioning with lactate-enriched blood

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We have previously reported that postconditioning with lactateenriched blood (PCLeB) offers various protective effects, including excellent microcirculation recovery and less early inflammation, in patients with ST-segment elevation myocardial infarction (STEMI) undergoing reperfusion therapy [1][2][3][4]. In the present report, we describe the case of a patient with STEMI who was treated with primary percutaneous coronary intervention (PCI) using PCLeB, wherein dualloading scintigraphy with both thallium-201 and iodine-123 BMIPP showed an extensive discrepancy in their uptake within the reperfused myocardium, which may reflect a potent myocardial salvaging effect of PCLeB.

A 65-year-old man who had experienced chest pain for 5 h presented to our emergency room.

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“…Hence, primary percutaneous coronary intervention using postconditioning with lactate-enriched blood (PCLeB) was successfully performed without delay. We used our modified postconditioning protocol as previously described [1][2][3][4] (Fig. 1).…”