Effect Of Ischemic Postconditioning On Early Reperfusion Injury In Acute Myocardial Infarction Patients

Objective： To explore whether ischemic postconditioning can reduce earlyischemia/reperfusion injury (IRI) in acute myocardial infarction (AMI) patients, thusplaying a role in protecting the heart.Methods：Forty-two AMI patients who underwent emergency percutaneous coronaryintervention (PCI) admitted to our hospital were randomly divided into control group(n=22) and ischemia postconditioning group(n=20)．All AMI patients were gave coronaryangiography (CAG) which cleared and opened infarction related artery (IRA), controlgroup did not undergo any intervention measures within the first1minute reperfusion, andgave normal stent implantation operation immediately; postconditioning group wereunderwent1minute reperfusion after occluded IRA10second by filling balloon, IRA wasgetted reperfusion10second by withdrawing balloon，and repeated2times, placing normalstent implantation operations, restored coronary artery blood flow． Two groups ofpatients were collected2ml arterial blood before and2hours,1,2,3days after PCI, sentour biochemical laboratory using automatic biochemical analyzer tests CK-MB value,measured average area under CK-MB curve; two groups of patients were collected2mlarterial blood before and2hours after PCI, also sent our biochemical laboratory measuringCRP level; two groups of patients were collected2ml arterial blood before and2hoursafter PCI, centrifuging，separating serum and saving to-80℃, after specimen collectionwas completed, appling MDA kit and SOD kit and using ELISA method respectivelymeasured serum MDA and SOD level, comparing before and24hours ECG after PCI, andrecording the situation of ST segment fell back, and monitoring the cases of reperfusionarrhythmias(RA)．Results：1．The CK-MB value, average area under CK-MB curve were significantly lower inIPost group than in control group(P＜0.05), average area under CK-MB curve were roughly reduced27%in IPost group than in control group by Graphpad Prism5.02．2．The serum levels of CRP were significantly lower in IPost group than in control group(P＜0.05); before and2hours after PCI, the change tendency of serum levels of CK-MB andCRP by Pearson correlation analysis, the CRP along with the CK-MB changes submitspositive correlation(rcontrol group=0.238，P＜0.05；rIPost=0.187，P＜0.01), IPost group wasobviously lower than the control group．3．The serum levels of MDA were significantly lower while the serum SOD level was significantlyhigher in IPost group than in control group(P＜0.05); before and2hours after PCI, thechange tendency of serum levels of MDA and SOD by Pearson correlation analysis, IPostgroup negatively correlated with the change of MDA and SOD(r=-0.438, P=0.04),whilecontrol group were positively correlated(r=0.301，P=0.05)．4．The ST segment fall was faster in IPost group than in control group(60.0%vs45.5%,P＜0.05); IPost group significantly lower incidence of reperfusion arrhythmia (50%vs25%，P＜0.05), IPost group can significantly less fast arrhythmia incidence(P＜0.05),two patients in control group died of malignant arrhythmia, but ischemic postconditioninggroup do not die．Conclusion：Ischemic postconditoning may be inhibited early reperfusion injury byreducing oxygen free radicals, strengthening the antioxidant response and inhibition ofinflammation, play a protective role in myocardial cells; while promoting the ST segment,myocardial reperfusion therapy effectively reduce reperfusion arrhythmias.