Abstract 9812: Cardioprotection by Postconditioning With Lactate-enriched Blood in Patients With ST-elevation Myocardial Infarction

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Objective: The beneficial effects of reperfusion therapy for ST-elevation myocardial infarction (STEMI) are attenuated by reperfusion injury. We reported that postconditioning with lactate-enriched blood (PCLeB) resulted in excellent microcirculation recovery and less inflammation in STEMI patients in our small-scale studies (AHA 2012, ACC 14). Here we analyzed all STEMI patients treated by PCLeB in our hospitals up to now. Methods: We treated 66 consecutive STEMI patients (age, 65.2 ± 14.9 y; 80.3% males) using PCLeB within 12 h of MI onset (mean ischemia time, 5.0 ± 3.0 h), including 31 patients with proximal LAD occlusion. Our modified protocol aims to achieve controlled reperfusion with cellular oxygenation and minimal lactate washout. The duration of each brief reperfusion was prolonged stepwise from 10 to 60 s. Lactated Ringer’s solution (20-30 mL), containing 28 mM lactate, was injected directly into the culprit coronary artery at the end of each reperfusion, and a balloon was quickly inflated at the lesion site, trapping lactate inside the ischemic myocardium. Each brief ischemic period lasted 60 s. After 7 cycles of balloon inflation and deflation, full reperfusion was performed, and stenting was performed thereafter. Results: The mean peak CK and CK-MB values were 2932 ± 2098 and 306 ± 224 IU/L, respectively. The mean corrected TIMI frame count after PCI was 18.5 ± 10.2 frames (normal value, 21 frames). After excluding 6 patients with extra-cardiac inflammatory disorders, the mean peak CRP value within 7 days of MI onset was 3.4 ± 2.9 mg/dL in the remaining 60 patients. Thallium-201 scintigraphy before discharge consistently revealed well-preserved myocardial viability, which appeared disproportionate to peak CK values. Thallium images of the last 10 patients with proximal LAD occlusion are presented in the Figure as a bull’s eye display labeled with each corresponding peak CK value (IU/L). Conclusion: PCLeB provides good cardioprotection in STEMI patients.