Renoprotective effect of remote ischemic postconditioning in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

Abstract

BackgroundWhether upper arm remote ischemic postconditioning (RIPostC) exerts protection to kidney in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) remains unknown.MethodsSixty-four patients with STEMI were randomized to PPCI + RIPostC (n=29) and PPCI (n=35) groups. RIPostC consisting of 4 cycles of 5 minutes occlusion/reperfusion by cuff inflation/deflation of the upper arm was started within 1 minute after the first balloon dilatation. Peripheral venous blood samples were collected before PPCI and at 0.5, 8, 24, 48, and 72 hours after PPCI to detect serum creatinine (SCr) and creatine kinase-MB (CK-MB). Acute kidney injury (AKI) rate and estimated glomerular filtration rate (eGFR) were calculated. The transthoracic echocardiography was performed 7 days after PPCI to assess left ventricular ejection fraction (LVEF).ResultsThe patients in the PPCI + RIPostC group had a lower AKI rate compared with those in the PPCI group (P=0.04). The eGFR after PPCI increased in the PPCI + RIPostC group compared to the PPCI group (P<0.01). The peak of CK-MB concentration in the PPCI + RIPostC group was significantly lower than that in the PPCI group (P<0.01). The area under the curve of CK-MB decreased in the PPCI + RIPostC group compared with that in the PPCI group. LVEF in the PPCI + RIPostC group was significantly higher than that in the PPCI group (P=0.04).ConclusionUpper arm RIPostC exerts renal and cardiac protection following cardiac ischemia–reperfusion in patients with STEMI.

The efficiency of remote ischemic preconditioning on serum cystatin C-based acute kidney injury in patients undergoing coronary angiography; a randomized controlled trial

“…Base on this necessity, an intervention has been described consisting of several transient non-lethal ischemia cycles called remote ischemic conditioning (RIC) (9). One of the most common approaches of RIC is the RIPC method which we used in the present study (19). Several authors in their studies showed the renoprotective of RIPC during surgeries (20).…”

Immediate remote ischemic postconditioning reduces cerebral damage in ischemic stroke mice by enhancing leptomeningeal collateral circulation

“…G-CSF: granulocyte colony-stimulating factor RIC represents a highly translatable therapy for multiorgan protection against ischemia-reperfusion injury (IRI). A growing number of clinical trials have indicated that RIC exerts therapeutic effects, specifically in the heart (Cao, Zhang, Wang, Xia, & Yang, 2018;Cho et al, 2017) and brain (England et al, 2017;Pico et al, 2016). However, to date, a clear understanding of the mechanism through which RIC exerts its functional benefits remains a key hurdle in its clinical translation.…”

Influence of Cardiovascular Risk Factors, Comorbidities, Medication Use and Procedural Variables on Remote Ischemic Conditioning Efficacy in Patients with ST-Segment Elevation Myocardial Infarction

“…In the clinical setting, application of RIC by short-term intermittent episodes of I-R is most often applied on the upper-arm and induced by alternating inflations and deflations of a standard blood pressure cuff above systolic blood pressure. In patients with STEMI treated with PPCI, proof of concept studies have demonstrated that RIC reduces cardiac biomarker release [27,28,38] and infarct size [30], improves myocardial salvage [24,31], that is, the proportion of the ischemic myocardium at risk of infarction being salvaged by the assigned treatment [47], ST-segment resolution on electrocardiogram [23] and peripheral endothelial function [29], as well as reduce the incidence of acute kidney injury [39]. Most importantly RIC reduces cardiac mortality and rehospitalisation for heart failure [40].…”