Remote Ischemic Postconditioning: Does It Protect against Ischemic Damage in Percutaneous Coronary Revascularization? Justification and Design of a Randomized Placebo-Controlled Clinical Trial

Abstract

Objective: Myocardial damage that is associated with percutaneous coronary intervention (PCI) partially affects the results of the procedure, and is related to medium-term cardiovascular death. Remote postischemic conditioning might reduce the myocardial lesions that are associated with PCI, but perhaps less so in diabetics. The aim of this study was to evaluate the protective effect of remote postischemic conditioning in patients undergoing elective PCI for stable angina or non-ST elevation acute coronary syndrome with troponin <1 ng/ml at the time of randomization. Methods: This randomized single-blinded single-center clinical trial involved 320 patients undergoing elective PCI who were randomized to either receive three 5-min cycles of ischemia by inflation of a cuff on the non-dominant arm to 200 mm Hg (remote postischemic conditioning) or to placebo (uninflated cuff). The primary outcome variable was the maximum increase in troponin in the first 24 h. The secondary outcome variable was readmission due to heart failure or cardiovascular mortality after 1 year of follow-up. In addition, a diabetic population was studied. Conclusions: This clinical trial evaluated the possible reduction in intervention-related myocardial damage that was attributable to remote postischemic conditioning.

Cardioprotective effect of remote ischemic postconditioning on children undergoing cardiac surgery: a randomized controlled trial

“…The RPostC protocol was carried out as previously described with a minor modification. A blood pressure cuff that had a width covered about 1/2–2/3 of the thigh was wrapped around one of the lower limbs.…”

“…In addition, it is very interesting that RPostC has a broad therapeutic time window, from immediately to 2 days after I/R injury . Nonetheless, no clinical studies have evaluated the protective effect of RPostC, except for some clinical trials in progress . In the present study, we performed a randomized controlled clinical study to evaluate the cardio‐cerebral protective effects of RPostC on children undergoing open‐heart surgery for repair of CHD.…”

Remote Limb Ischaemic Postconditioning Protects Against Myocardial Ischaemia/Reperfusion Injury in Mice: Activation of JAK/STAT3-Mediated Nrf2-Antioxidant Signalling

“…However, the local ischaemic postconditioning strategy involves repetitive trauma to the artery that may contribute to restenosis, which limits its clinical application in organs that have suffered life-threatening ischaemia. Compared with local ischaemic postconditioning, remote limb ischaemic postconditioning (RIPostC) by repeated occlusion/release cycles in the lateral femoral artery is an effective, feasible and non-invasive method to exert cardioprotection to prevent IR insult [4, 7, 8]. The cardioprotection induced by ischaemic pre-, post- and remote conditioning has shown promising results, reducing infarct size and improving clinical outcomes in patients with ischaemic heart disease.…”

Remote ischaemic postconditioning: does it protect against ischaemic damage in percutaneous coronary revascularisation? Randomised placebo-controlled clinical trial

“…Our initial aim was to include a total of 320 patients, as mentioned previously 15. However, once 80% of the proposed study sample had been enrolled, an intermediate analysis was carried out with the aim of stopping the study in the event that there were no significant differences between the two arms, and that in addition, there was no trend towards significance that could have become significant after enrolment of the full 320 patients.…”

“…Special attention was given to the diabetic patients. The primary endpoint was to determine whether an RIP protocol reduced the myocardial damage associated with the RIP measured by the maximum elevation of troponin I during the first 24 h as compared with a control group 15 16…”