Conditioned blood reperfusion during angioplasty (CoBRA) treatment of acute myocardial infarction

Acute myocardial infarct (MI) results in ischemia distal to lesions which p uts heart muscle at risk for reperfusion injury (RI). Neutrophils, platelet s and complement are putative mediators of RI. Recent advances in filtratio n technology provide integrated neutrophil and platelet removal together wi th complement-attenuating properties in a single blood-conditioning device. The present study characterizes the properties of a blood-conditioning fil ter and describes its clinical effect when used in conjunction with active hemoperfusion for acute MI. The filter reduces leukocytes by 99.9998 +/- 0.0002% (p < 0.0001) and plate lets by 99.9934 +/- 0.0069% (p < 0.0001). Human plasma, derived from hepari nized blood that was 'conditioned' by filtration, was studied using the Lan gendorff isolated rabbit heart preparation. The deposition of membrane atta ck complex and the resultant functional myocardial impairments [reflected i n hemodynamic and biochemical measurements, including developed pressure, c oronary blood flow, lymph-derived myocardial creatine kinase (CK)] are sign ificantly attenuated by blood conditioning. Integration of the blood-condit ioning filter into an active hemoperfusion system during primary percutaneo us transluminal coronary angioplasty (PTCA) for acute MI (n = 8) did not de lay the procedure or cause any complications. Reperfusion of occluded coron ary arteries with 300 cm(3) of conditioned blood led to significant improve ment in echocardiographic global wall motion scores (in standard deviations ) following treatment (-1.64 +/- 0.18 to -1.45 +/- 0.15, p = 0.02). Initial reperfusion of totally occluded coronary arteries with conditioned blood leads to acutely improved ventricular function. Collectively, these d ata provide a strong indication for continued investigation of conditioned blood reperfusion in angioplasty following acute MI for the long-term effec t upon recovery of salvagable myocardium.