Skip to main content
Log in

’Postconditioning’ the human heart: Multiple balloon inflations during primary angioplasty may confer cardioprotection

  • Published:
Basic Research in Cardiology Aims and scope Submit manuscript


Growing evidence from experimental models suggests that relief of myocardial ischemia in a stuttering manner (i.e., ’postconditioning’ [PostC] with brief cycles of reperfusion-reocclusion) limits infarct size. However, the potential clinical efficacy of PostC has, to date,been largely unexplored. Using a retrospective study design, our aim was to test the hypothesis that creatine kinase release (CK: clinical surrogate of infarct size) would be attenuated in ST-segment elevation myocardial infarction (STEMI) patients requiring multiple balloon inflations-deflations during primary angioplasty versus STEMI patients who received minimal balloon inflations and/or direct stenting. To investigate this concept, we reviewed the records of all STEMI patients with single vessel occlusion who presented to our institution from November 2004 – April 2006 for primary angioplasty. Exclusion criteria were: previous MI, cardiogenic shock, patients resuscitated from cardiac arrest, or pre-infarct angina. Patients were prospectively divided into two subsets: those receiving 1–3 balloon inflations (considered the minimum range to achieve patency and stent placement) versus those in whom 4 or more inflations were applied. Peak CK release was significantly lower in patients requiring ≥4 versus 1–3 inflations (1655 versus 2272 IU/L; p<0.05), an outcome consistent with the concept that relief of sustained ischemia in a stuttered manner (analogous to postconditioning) may evoke cardioprotection in the clinical setting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. Argaud L, Gateau-Roesch O, Raisky O, Loufouat J, Robert D, Ovize M (2005) Post-conditioning inhibits mitochondrial permeability transition. Circulation 111:194–197

    Article  CAS  PubMed  Google Scholar 

  2. Chiari PC, Bienengraeber MW, Pagel PS,Krolikowski JG,Kersten JR,Warltier DC (2005) Isoflurane protects against myocardial infarction during early reperfusion by activation of phosphatidylinositol- 3-kinase signal transduction: evidence for anesthetic-induced postconditioning in rabbits. Anesthesiology 102:102–109

    Article  CAS  PubMed  Google Scholar 

  3. Darling C, Maynard M, Whittaker P, Przyklenk K (2006) ’Elderly’ mice are refractory to postconditioning-induced cardioprotection. Acad Emerg Med 13:S134

    Article  Google Scholar 

  4. Darling CE, Jiang R,Maynard M,Whittaker P,Vinten-Johansen J, Przyklenk K (2005) Postconditioning via stuttering reperfusion limits myocardial infarct size in rabbit hearts: role of ERK1/2. Am J Physiol Heart Circ Physiol 289:H1618–H1626

    Article  CAS  PubMed  Google Scholar 

  5. Darling CE, Przyklenk K (2005) ’Postconditioning’: a new paradigm for myocardial protection? Curr Card Rev 1:195–201

    Article  Google Scholar 

  6. Di Chiara A, Plewka M, Werren M, Badano LP, Fresco C, Fioretti PM (2006) Estimation of infarct size by single measurements of creatine kinase levels in patients with a first myocardial infarction. J Cardiovasc Med (Hagerstown) 7:340–346

    Article  Google Scholar 

  7. Halkos ME,Kerendi F,Corvera JS,Wang NP, Kin H, Payne CS, Sun HY, Guyton RA,Vinten-Johansen J, Zhao ZQ (2004) Myocardial protection with postconditioning is not enhanced by ischemic preconditioning. Ann Thorac Surg 78:961–969

    Article  PubMed  Google Scholar 

  8. Iliodromitis EK, Georgiadis M, Cohen MV,Downey JM, Bofilis E,Kremastinos DT (2006) Protection from postconditioning depends on the number of short ischemic insults in anesthetized pigs. Basic Res Cardiol 101:502–507

    Article  PubMed  Google Scholar 

  9. Kin H, Zatta AJ, Lofye MT,Amerson BS, Halkos ME,Kerendi F,Zhao ZQ,Guyton RA, Headrick JP, Vinten-Johansen J (2005) Postconditioning reduces infarct size via adenosine receptor activation by endogenous adenosine. Cardiovasc Res 67:124–133

    Article  CAS  PubMed  Google Scholar 

  10. Kloner RA, Przyklenk K, Shook T, Cannon CP (1998) Protection conferred by preinfarct angina is manifest in the aged heart: evidence from the TIMI 4 Trial. J Thromb Thrombolysis 6:89–92

    Article  PubMed  Google Scholar 

  11. Penna C, Cappello S, Mancardi D, Raimondo S, Rastaldo R, Gattullo D, Losano G,Pagliaro P (2006) Post-conditioning reduces infarct size in the isolated rat heart: role of coronary flow and pressure and the nitric oxide/ cGMP pathway. Basic Res Cardiol 101:168–179

    Article  CAS  PubMed  Google Scholar 

  12. Philipp S, Yang XM, Cui L, Davis AM, Downey JM,Cohen MV (2006) Postconditioning protects rabbit hearts through a protein kinase C-adenosine A2b receptor cascade. Cardiovasc Res 70:308–314

    Article  CAS  PubMed  Google Scholar 

  13. Piper HM, Meuter K, Schafer C (2003) Cellular mechanisms of ischemiareperfusion injury. Ann Thorac Surg 75:S644–S648

    Article  PubMed  Google Scholar 

  14. Przyklenk K (1997) Lethal myocardial reperfusion injury: the opinions of good men. J Thromb Thrombolysis 4:5–6

    Article  PubMed  Google Scholar 

  15. Staat P, Rioufol G, Piot C,Cottin Y,Cung TT, L’Huillier I, Aupetit JF, Bonnefoy E, Finet G,Andre-Fouet X,Ovize M (2005) Postconditioning the human heart. Circulation 112:2143–2148

    Article  PubMed  Google Scholar 

  16. Tsang A, Hausenloy DJ, Mocanu MM, Yellon DM (2004) Postconditioning: a form of "modified reperfusion" protects the myocardium by activating the phosphatidylinositol 3-kinase-Akt pathway. Circ Res 95:230–232

    Article  CAS  PubMed  Google Scholar 

  17. Vinten-Johansen J, Zhao Z-Q, Zatta AJ, Kin H, Halkos ME, Kerendi F (2005) Postconditioning: A new link in nature’s armor against myocardial ischemiareperfusion injury. Basic Res Cardiol 100:295–310

    Article  CAS  PubMed  Google Scholar 

  18. Wang QD, Pernow J, Sjoquist PO,Ryden L (2002) Pharmacological possibilities for protection against myocardial reperfusion injury. Cardiovasc Res 55:25–37

    Article  CAS  PubMed  Google Scholar 

  19. Yang XM, Downey JM, Cohen MV (2005) Postconditioning’s protection is not dependent on circulating blood factors or cells but requires PI3-kinase and guanylyl cyclase activation. Basic Res Cardiol 100:57–63

    Article  CAS  PubMed  Google Scholar 

  20. Yang XM, Proctor JB, Cui L, Krieg T, Downey JM, Cohen MV (2004) Multiple, brief coronary occlusions during early reperfusion protect rabbit hearts by targeting cell signaling pathways. J Am Coll Cardiol 44:1103–1110

    Article  PubMed  Google Scholar 

  21. Zhao ZQ, Corvera JS, Halkos ME, Kerendi F, Wang NP, Guyton RA, Vinten- Johansen J (2003) Inhibition of myocardial injury by ischemic postconditioning during reperfusion: comparison with ischemic preconditioning. Am J Physiol Heart Circ Physiol 285:H579–H588

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to K. Przyklenk PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Darling, C.E., Solari, P.B., Smith, C.S. et al. ’Postconditioning’ the human heart: Multiple balloon inflations during primary angioplasty may confer cardioprotection. Basic Res Cardiol 102, 274–278 (2007).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

Key words