Late Remote Ischemic Preconditioning Provides Benefit to Patients Undergoing Elective Percutaneous Coronary Intervention

Abstract

To assess whether late remote ischemic preconditioning (L-RIPC) is effective in myocardial protection in patients with ischemic heart disease undergoing elective percutaneous coronary intervention (PCI). L-RIPC is exerted by newly synthesized cardioprotective proteins. The cardioprotective effects of L-RIPC are more durable. 200 consecutive patients undergoing elective PCI were randomized to receive L-RIPC (induced by three 5-minute inflations of a blood pressure cuff to 200 mmHg around the upper arm, followed by 5-min intervals of reperfusion) or control (an uninflated cuff around the arm) at 18 h before PCI. Creatine phosphokinase (CK), its cardiac isoenzyme (CK-MB), troponin I (TNI), and high-sensitivity C-reactive protein (hs-CRP) levels were measured at 24 h after PCI. Adverse events' rates at 6 months were assessed. Compared with the control group, patients in L-RIPC group were observed with significantly lower incidences in Chest pain score >1 and ECG ST deviation >1 mm (P < 0.05). The median TNI, CK, and CK-MB concentrations at 24 h were lower in the L-RIPC group (0.009 vs. 0.036 ng/mL, 123 vs. 186 IU/L, 15 vs. 27 IU/L; P < 0.05). There was no statistical difference in hs-CRP between two groups. At 6 months, the adverse events' rate was lower in the L-RIPC group (P = 0.036). L-RIPC is effective in myocardial protection in patients undergoing elective PCI and reduces adverse events' rate at 6 months.

Kinetics and Signal Activation Properties of Circulating Factor(s) From Healthy Volunteers Undergoing Remote Ischemic Pre-Conditioning

“…The continuous presence of a circulating factor that provides cardioprotection in the bioassay mouse heart in the present study is again consistent with prior experimental and clinical studies, which revealed evidence of long-lasting protection 24, 26, 27, 39 for up to 1 week after the RIPC stimulus (28). In contrast to our present study, however, these studies could not distinguish between a long-lasting presence of a circulating factor or a long-lasting protective effect in the target organ.…”

“…Prior studies have reported a time delay between the RIPC stimulus and the injurious event from 5 to 10 min 22, 23 to more than 24 h 24, 25, 26, 27, suggesting that RIPC is a fast acting as well as a long-lasting phenomenon. Supporting the notion of a long-lasting effect, flow-mediated forearm vasodilation in patients with reperfused acute myocardial infarction was improved by RIPC for 1 week (28).…”

Time to Give Up on Cardioprotection?

“…A retrospective analysis of the CONDI trial (Effect of Remote Ischemic Conditioning on Clinical Outcome in (Table 3). A similar pattern with infarct size reduction in the majority but not all studies (with 2 small extreme outlier studies reporting even increased infarct size by remote ischemic preconditioning 114,115 ) emerged for elective PCI when either remote ischemic pre- [116][117][118][119][120][121][122][123] or postconditioning 124,125 was used for cardioprotection. In some of these studies, clinical outcome was reported as a secondary outcome, and it was either not different 106,119,124 or improved.…”

The impact of a single episode of remote ischemic preconditioning on myocardial injury after elective percutaneous coronary intervention

“…Prasad et al [28] used a different protocol and delivered 3 cycles of 3-minute ischemia/reperfusion immediately before PCI, but they were not able to show cardioprotection. Unlike the studies of classical preconditioning, Liu et al demonstrated that late RIPC also had beneficial effects on patients undergoing elective PCI [29]. Although there is heterogeneity in RIPC protocols, meta-analyses of the major RIPC studies in elective PCI indicated that ischemic preconditioning had beneficial effects on post-PCI myocardial injury [31–33].…”