Post-Conditioning Reduces Infarct Size and Edema in Patients With ST-Segment Elevation Myocardial Infarction

Thuny, Franck; Lairez, Olivier; Roubille, François; Mewton, Nathan; Rioufol, Gilles; Sportouch, Catherine; Sanchez, Ingrid; Bergerot, Cyrille; Thibault, Hélène; Cung, Thien Tri; Finet, Gérard; Argaud, Laurent; Revel, D.; Dérumeaux, Geneviève; Bonnefoy‐Cudraz, Eric; Elbaz, Meyer; Piot, Christophe; Ovize, Michel; Croisille, Pierre

doi:10.1016/j.jacc.2012.03.026

Cited by 205 publications

(181 citation statements)

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“…Improvements were seen in myocardial perfusion and functional outcomes compared with those in patients who did not undergo postconditioning. Thuny, et al 41) randomly assigned 50 patients with STEMI to either a control group or postconditioned group. Postconditioning was associated with smaller infarct size ( ; P < 0.03).…”

Section: Non-pharmacological Cardioprotectionmentioning

confidence: 99%

Etiology and Clinical Implications of Microvascular Dysfunction in Patients With Acute Myocardial Infarction

Ito

2014

Int. Heart J.

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SummaryIn patients with acute myocardial infarction (MI), coronary microvasculatures are often damaged irreversibly due to myocardial ischemia and reperfusion, and fl ow to the previously ischemic myocardium is markedly reduced, a phenomenon known as the "no-refl ow phenomenon". Percutaneous coronary intervention (PCI) may accelerate embolization of plaque gruels and microthrombi to the microvessels, which further reduces tissue perfusion. The extent of the no-refl ow zone correlates with infarct size, and it has additional prognostic information. Recent advances in imaging modalities have enabled us to diagnose the no-refl ow phenomenon and to assess the mechanisms of the no-refl ow phenomenon. Pharmacological interventions and catheter-based devices to retrieve embolic materials have been proposed, and some of them are associated with improvement in clinical outcomes. Thus, we should keep in mind that only the achievement of complete microvascular perfusion is associated with better functional and clinical outcomes in patients with acute MI. (Int Heart J 2014; 55: 185-189) Key words: Echocardiography, Myocardial perfusion, Reperfusion, Myocardial ischemia, Microcirculation, Myocardial viability, Prognosis, Ventricular function A cute myocardial infarction (MI) is caused by obstruction of a coronary artery by a thrombus on a ruptured plaque. Salvaging threatened myocardium after acute coronary occlusion has been a key therapeutic objective. Percutaneous coronary intervention (PCI) with coronary stenting is widely performed for this purpose. PCI, however, does not necessarily guarantee the recovery of blood fl ow at the microvascular level, because myocardial ischemia often injures the coronary microvasculature structurally.1-3) This is called the noreflow phenomenon.4) If this phenomenon occurs, it significantly attenuates the benefi cial impacts of reperfusion therapy, resulting in poor clinical and functional outcomes. [1][2][3]5) The PCI procedure itself may worsen the microvascular function. Balloon inflation and stenting may introduce embolization of plaque and thrombus debris, resulting in obstruction in distal coronary small arteries and arterioles. Atheroembolism and/or thromboembolism could limit the effi cacy of PCI. 6)Attention is currently shifting from "no-fl ow" to "no-refl ow". We should ascertain the patency to determine the status of the coronary microvasculature in each patient with acute MI in order perform risk stratifi cation. With the advancement of imaging modalities, which include myocardial contrast echocardiography, Doppler guidewire, and cardiac magnetic resonance imaging, the number of patients with the no-refl ow phenomenon has increased compared to the rates that we deemed. Our ultimate therapeutic goal is to achieve successful microvascular reperfusion. In this review, I attempt to provide an in-depth understanding of the no-refl ow phenomenon from the bench to the bedside.

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Section: Non-pharmacological Cardioprotectionmentioning

confidence: 99%

Etiology and Clinical Implications of Microvascular Dysfunction in Patients With Acute Myocardial Infarction

Ito

2014

Int. Heart J.

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“…[1] Since Zhao et al [2] proposed the concept of ischemic post-conditioning in 2003, many studies have demonstrated that postconditioning can alleviate reperfusion injuries. [3][4][5][6] Post-conditioning must be performed strictly according to the protocols, namely post-conditioning algorithms, [7] or it will lose the cardioprotection effect. To the present, no "ideal" algorithm has been established.…”

Section: Introductionmentioning

confidence: 99%

Post-conditioning with gradually increased reperfusion provides better cardioprotection in rats

Zhang

Wang

et al. 2014

World Journal of Emergency Medicine

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“…Recently, the protective effect of RPostC against focal cerebral ischemia in rats was also verified [16]. However, its potential protective mechanisms have not been established.Recent developments in cardiac physiology have indicated that PostC significantly reduces infarct size and inhibits inflammation and apoptosis [17][18][19][20][21]. Zhao [22] at first documented that PostC reduced infarct size in cerebral I/R injury.…”

mentioning

confidence: 99%

Effects of Limb Remote Postconditioning on Apoptosis and Long-Term Neurological Outcomes of Focal Cerebral Ischemia/Reperfusion Injury in Rats

Li¹,

Jiang²

2015

J Diabetes Metab

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Background and Purpose: Remote ischemic postconditioning (RPostC) is an emerging concept for cerebral infarction protection, and it has better application prospects in clinical practice. However, little is known about the neuroprotection mechanisms of RPostC in cerebral ischemia/reperfusion (I/R) injury. In the present study, we investigated the effects of RPostC on neural cells apoptosis and long-term neurological outcomes in focal cerebral I/R injury in the rat middle cerebral artery occlusion model. Methods:Focal cerebral ischemia was induced by middle cerebral artery occlusion using the intraluminal filament technique in male rats. RPostC was generated by 3 cycles of femoral artery 10-minute occlusion/reperfusion on the right limb at the onset of middle cerebral artery reperfusion. Adult male wistar rats were treated with remote post conditioning after 90 minutes of occlusion (beginning of reperfusion). Infarct volumes were assessed at 24h and 21d of stroke onset. Neurological scores were assessed at 24h and 3d,5d, 7d,10d, 14, 21d after the onset of middle cerebral artery reperfusion. Apoptosis-related molecules were studied at 24h of stroke onset by Western blotting.Results: RPostC treatment up-regulated Bcl-2 and heat-shock protein 70 (HSP70) expression and downregulated Bax expression. RPostC treatment also reduced infarct volumes at 24h and 21d, meanwhile, it also improved the neurologic scores and the long-term neurological outcomes compared with the I/R-only group. Conclusion:These findings indicate that RPostC inhibits focal cerebral I/R injury and improves the neurological outcomes. This neuroprotective effect is likely achieved by anti-apoptotic mechanisms. Effects of Limb IntroductionBrain ischemia is becoming a leading cause of morbidity and mortality world-wide [1]. Its major pathophysiological manifestation is an acute brain ischemia-reperfusion injury [2]. Despite extensive researchs on reperfusion injury treatment in the past several decades, few neuroprotectants have been successfully from basic research into clinical application. A variety of clinical trials of pharmacological neuroprotective strategies in stroke have been disappointing [3][4][5]. Therefore, innovative treatment strategies for protecting brain against the detrimental effects of this form of injury are required in order to improve clinical outcomes in patients with brain ischemic injury. Researchers are now interested in the brain's endogenous strategies for neuroprotection [6,7]. Harnessing the endogenous protection elicited by the brain's ability to "condition" itself has recently emerged as a powerful new strategy for limiting brain injury [8,9].Ischemic postconditioning (PostC), which is defined as rapid intermittent interruptions of blood flow in the early phase of reperfusion and mechanically alters the hydrodynamics of reperfusion, has been verified to protect tissues from I/R injury [10]. The clinical applicability of PostC is limited because PostC can interrupt intermittent reperfusion of vital organs and re...

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Post-Conditioning Reduces Infarct Size and Edema in Patients With ST-Segment Elevation Myocardial Infarction

Abstract: This randomized study demonstrated that post-conditioning reduced infarct size and edema in patients with reperfused STEMI.

Cited by 205 publications

References 40 publications

Etiology and Clinical Implications of Microvascular Dysfunction in Patients With Acute Myocardial Infarction

Etiology and Clinical Implications of Microvascular Dysfunction in Patients With Acute Myocardial Infarction

Post-conditioning with gradually increased reperfusion provides better cardioprotection in rats

Effects of Limb Remote Postconditioning on Apoptosis and Long-Term Neurological Outcomes of Focal Cerebral Ischemia/Reperfusion Injury in Rats

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