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Circulation. 2005;112:2143-2148
Published online before print September 26, 2005, doi: 10.1161/CIRCULATIONAHA.105.558122
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(Circulation. 2005;112:2143-2148.)
© 2005 American Heart Association, Inc.


Heart Failure

Postconditioning the Human Heart

Patrick Staat, MD; Gilles Rioufol, MD, PhD; Christophe Piot, MD, PhD; Yves Cottin, MD, PhD; Thien Tri Cung, MD; Isabelle L’Huillier, MD; Jean-François Aupetit, MD, PhD; Eric Bonnefoy, MD, PhD; Gérard Finet, MD, PhD; Xavier André-Fouët, MD; Michel Ovize, MD, PhD

From Hôpital Cardiologique et Pneumologique Louis Pradel, Lyon (P.S., G.R., E.B., G.F., X.A.-F., M.O.); Hôpital Arnaud de Villeneuve, Montpellier (C.P., T.T.C.); Hôpital du Bocage, Dijon (Y.C., I.L.); Hôpital Saint Luc–Saint Joseph, Lyon (J.-F.A.); and Inserm E 0226, Lyon (G.R., G.F., M.O.), France.

Correspondence to Professor Michel Ovize, Hôpital L. Pradel, Hospices Civils de Lyon, 59, Bd Pinel, 69394 Lyon Cedex 03, France. E-mail ovize{at}sante.univ-lyon1.fr

Received April 25, 2005; revision received June 2, 2005; accepted June 17, 2005.

Background— In animal models, brief periods of ischemia performed just at the time of reperfusion can reduce infarct size, a phenomenon called postconditioning. In this prospective, randomized, controlled, multicenter study, we investigated whether postconditioning may protect the human heart during coronary angioplasty for acute myocardial infarction.

Methods and Results— Thirty patients, submitted to coronary angioplasty for ongoing acute myocardial infarction, contributed to the study. Patients were randomly assigned to either a control or a postconditioning group. After reperfusion by direct stenting, control subjects underwent no further intervention, whereas postconditioning was performed within 1 minute of reflow by 4 episodes of 1-minute inflation and 1-minute deflation of the angioplasty balloon. Infarct size was assessed by measuring total creatine kinase release over 72 hours. Area at risk and collateral blood flow were estimated on left ventricular and coronary angiograms. No adverse events occurred in the postconditioning group. Determinants of infarct size, including ischemia time, size of the area at risk, and collateral flow, were comparable between the 2 groups. Area under the curve of creatine kinase release was significantly reduced in the postconditioning compared with the control group, averaging 208 984±26 576 compared with 326 095±48 779 (arbitrary units) in control subjects, ie, a 36% reduction in infarct size. Blush grade, a marker of myocardial reperfusion, was significantly increased in postconditioned compared with control subjects: 2.44±0.17 versus 1.95±0.27, respectively (P<0.05).

Conclusions— This study suggests that postconditioning by coronary angioplasty protects the human heart during acute myocardial infarction.


Key Words: ischemia • myocardial infarction • postconditioning • reperfusion


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M. R. Schmidt, M. Smerup, I. E. Konstantinov, M. Shimizu, J. Li, M. Cheung, P. A. White, S. B. Kristiansen, K. Sorensen, V. Dzavik, et al.
Intermittent peripheral tissue ischemia during coronary ischemia reduces myocardial infarction through a KATP-dependent mechanism: first demonstration of remote ischemic perconditioning
Am J Physiol Heart Circ Physiol, April 1, 2007; 292(4): H1883 - H1890.
[Abstract] [Full Text] [PDF]


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CirculationHome page
L. H. Opie and H. Selker
Letter by Opie and Selker Regarding Article, "Reperfusion Starts in the Ambulance"
Circulation, December 12, 2006; 114(24): e640 - e640.
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Am. J. Physiol. Heart Circ. Physiol.Home page
X.-L. Tang, H. Sato, S. Tiwari, B. Dawn, Q. Bi, Q. Li, G. Shirk, and R. Bolli
Cardioprotection by postconditioning in conscious rats is limited to coronary occlusions <45 min
Am J Physiol Heart Circ Physiol, November 1, 2006; 291(5): H2308 - H2317.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
M. Zhu, J. Feng, E. Lucchinetti, G. Fischer, L. Xu, T. Pedrazzini, M. C. Schaub, and M. Zaugg
Ischemic postconditioning protects remodeled myocardium via the PI3K-PKB/Akt reperfusion injury salvage kinase pathway
Cardiovasc Res, October 1, 2006; 72(1): 152 - 162.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Heart Circ. Physiol.Home page
N. Couvreur, L. Lucats, R. Tissier, A. Bize, A. Berdeaux, and B. Ghaleh
Differential effects of postconditioning on myocardial stunning and infarction: a study in conscious dogs and anesthetized rabbits
Am J Physiol Heart Circ Physiol, September 1, 2006; 291(3): H1345 - H1350.
[Abstract] [Full Text] [PDF]


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Anesth. Analg.Home page
C. Wang, D. A. Neff, J. G. Krolikowski, D. Weihrauch, M. Bienengraeber, D. C. Warltier, J. R. Kersten, and P. S. Pagel
The influence of B-cell lymphoma 2 protein, an antiapoptotic regulator of mitochondrial permeability transition, on isoflurane-induced and ischemic postconditioning in rabbits.
Anesth. Analg., May 1, 2006; 102(5): 1355 - 1360.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
D. Garcia-Dorado, J. Vinten-Johansen, and H. M. Piper
Bringing preconditioning and postconditioning into focus
Cardiovasc Res, May 1, 2006; 70(2): 167 - 169.
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Cardiovasc ResHome page
D. Ramzy, V. Rao, and R. D. Weisel
Clinical applicability of preconditioning and postconditioning: The cardiothoracic surgeons's view
Cardiovasc Res, May 1, 2006; 70(2): 174 - 180.
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Cardiovasc ResHome page
Z.-Q. Zhao and J. Vinten-Johansen
Postconditioning: Reduction of reperfusion-induced injury
Cardiovasc Res, May 1, 2006; 70(2): 200 - 211.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
D. J. Hausenloy and D. M. Yellon
Survival kinases in ischemic preconditioning and postconditioning
Cardiovasc Res, May 1, 2006; 70(2): 240 - 253.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
O. Gateau-Roesch, L. Argaud, and M. Ovize
Mitochondrial permeability transition pore and postconditioning
Cardiovasc Res, May 1, 2006; 70(2): 264 - 273.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
R. A. Kloner and S. H. Rezkalla
Preconditioning, postconditioning and their application to clinical cardiology
Cardiovasc Res, May 1, 2006; 70(2): 297 - 307.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
S. Philipp, X.-M. Yang, L. Cui, A. M. Davis, J. M. Downey, and M. V. Cohen
Postconditioning protects rabbit hearts through a protein kinase C-adenosine A2b receptor cascade
Cardiovasc Res, May 1, 2006; 70(2): 308 - 314.
[Abstract] [Full Text] [PDF]


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CirculationHome page
W. K. Laskey, P. Staat, G. Rioufol, E. Bonnefoy, G. Finet, X. Andre-Fouet, M. Ovize, C. Piot, T. T. Cung, Y. Cottin, et al.
Letter Regarding Article by Staat et al, "Postconditioning the Human Heart"
Circulation, March 28, 2006; 113(12): e665 - e665.
[Full Text] [PDF]