Ischemic Conditioning as an Adjunct to Percutaneous Coronary Intervention

Schevchuck, Alex; Laskey, Warren K.

doi:10.1161/circinterventions.113.000146

Cited by 12 publications

(23 citation statements)

References 86 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this study involving a small number of patients, they showed a reduction in myocardial infarct size, as estimated by the blood levels of creatine kinase. However, afterwards, small size randomized trials [14] and, more recently, larger randomized studies [15], [16], [17] have reported a lack of reproducibility of the IPostC response. The source of disagreement is not clear but it is possible that the lack of uniformity on the IPostC protocol between studies may play a role.…”

Section: Introductionmentioning

confidence: 99%

Ischemic postconditioning of the isolated human myocardium: Role of the applied protocol

Casós

Pérez

Blasco-Lucas

et al. 2015

IJC Heart & Vasculature

View full text Add to dashboard Cite

BackgroundIschemic postconditioning (IPostC), has been proposed as a useful approach to reduce infarct size in all species, but its clinical utility remains unclear.ObjectiveTo investigate the role played by the protocol used on the efficacy of IPostC in protecting the diseased human myocardium.MethodsMyocardial atrial samples from patients were subjected to a 90 min ischemia/120 min reoxygenation followed by different IPostC protocols to investigate the role of the time of ischemia (30, 60, 90 and 120 s) and the number of cycles (1, 2, 3 and 4) with 60 and 120 s of total ischemic time. Muscles were also subjected to ischemic preconditioning (IPreC). The release of lactate dehydrogenase (LDH) and the measurement of tetrazolium bromide (MTT) were determined.ResultsIPostC increased the LDH and decreased the MTT values from those of control, independently of the duration of the conditioning ischemia. LDH and MTT values also worsened by augmenting the number of IPostC cycles whereas they were significantly improved by IPreC. However, analysis of individual results indicated that in approximately 1/3 of the cases IPostC exhibited some degree of protection especially in the presence of increased ischemic injury.ConclusionsThe present findings show that IPostC of the human myocardium may be influenced by the protocol used and also by the degree of the preceding ischemic injury. IPostC was beneficial in approximately 1/3 of the cases; however in the remaining cases it increased ischemic damage and, therefore, these results raise a word of caution on its broad clinical use.

show abstract

Section: Introductionmentioning

confidence: 99%

Ischemic postconditioning of the isolated human myocardium: Role of the applied protocol

Casós

Pérez

Blasco-Lucas

et al. 2015

IJC Heart & Vasculature

View full text Add to dashboard Cite

show abstract

“…Postconditioning has shown promise, with significant reductions in infarct size both in animal models , and in humans , confirmed in vivo and ex vivo. However, there have been both positive and negative studies, and no gold standard algorithm or strategy has been agreed upon.…”

Section: Introductionmentioning

confidence: 94%

Ischaemic postconditioning: cardiac protection after the event

2015

View full text Add to dashboard Cite

Ischaemic heart disease remains the leading cause of death worldwide. Novel approaches to improve morbidity and mortality in this population are essential. Cardiac ischaemic postconditioning -the technique of applying alternating cycles of sublethal myocardial ischaemia and reperfusion after a sustained insult -is one cardioprotective strategy that can reduce reperfusion injury. Infarct size reduction and improvements in left ventricular ejection fraction have been demonstrated with mechanical or pharmacological postconditioning, both after spontaneous acute myocardial infarction, and associated with cardiac surgery. Nonetheless, the benefits of postconditioning can be easily attenuated. For maximal benefit, postconditioning demands a particular patient population (large area at risk, with little collateral blood flow), timely application and the measurement of appropriate clinical endpoints.

show abstract

“…A second wave of clinical studies, building on the momentum of these initial sanguine reports and using more sophisticated measures of myocardial salvage, eg, single-photon emission computed tomography, cardiac magnetic resonance, introduced an element of uncertainty into the mix, not only with respect to the correct methodology for the assessment of myocardial salvage, 10 but also with respect to the possibility of harm consequent to postconditioning. 11 These developments, in the face of inadequately powered studies to detect differences in nonsurrogate, hard clinical end points have begun to give increasing support to the insightful concerns of John Ioannidis, namely "Why most discovered true associations are inflated." 12 Is the current uncertainty regarding the presence or extent of the benefit of postconditioning in humans simply a matter of inadequately powered studies and inflated early estimates of the true effect?…”

Section: Article See P 1889mentioning

confidence: 99%

“…The magnitude of benefit conferred by postconditioning in humans is confined to a modest, albeit statistically significant, effect on biomarker and scintigraphic estimates of infarct size without persuasive evidence for improved clinical outcomes. 11 In addition to the sine qua non of early and gradual reperfusion, the benefit of postconditioning is highly dependent on the area at risk and the total ischemic time. 8 A beneficial postconditioning effect is most apt to be manifest with anterior infarcts and total ischemic times <3 hours (both with <50% prevalence in the current trial).…”

Section: Laskey and Schevchuckmentioning

confidence: 99%

“…8 A beneficial postconditioning effect is most apt to be manifest with anterior infarcts and total ischemic times <3 hours (both with <50% prevalence in the current trial). 11 The importance of the latter cannot be exaggerated given the many variables beyond our control in a patient experiencing an out-of-hospital myocardial infarction. 17 The current literature suggests little window for improvement in the extent of myocardial salvage with primary PCI occurring beyond 3 hours of total ischemic time.…”

Section: Laskey and Schevchuckmentioning

confidence: 99%

See 1 more Smart Citation