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

Abstract

IntroductionMyocardial injury after percutaneous coronary intervention (PCI) occurs in approximately 30% of procedures, and is related to worse prognosis. Effects of remote ischemic preconditioning (RIPC) on reperfusion injury have been investigated before, yielding conflicting results.AimTo assess the impact of a single episode of RIPC on myocardial injury after elective PCI.Material and methodsOne hundred and four patients undergoing elective PCI, with normal baseline cardiac troponin-I (cTn-I) values, were randomized to two groups. Two patients were excluded due to data loss, and 102 patients were analyzed. Five minutes of ischemic preconditioning was delivered just before the intervention to the preconditioning group, by inflating the blood pressure cuff up to 200 mm Hg on the non-dominant arm. Postprocedural 16th hour cTn-I, ΔcTn-I (difference between the 16th h and baseline cTn-I values) and the prevalence of type 4a myocardial infarction were compared between the two groups.ResultsMedian cTn-I values after the procedure were compared. 16th hour cTn-I was insignificantly lower in the preconditioning arm (0.026 μg/l vs. 0.045 μg/l, p = 0.186). The incidence of cTn-I elevation 5-fold above the upper reference limit (URL) (> 0.115 μg/l) was lower in the preconditioning group, but it was also not significant (21.6% vs. 11.8%, p = 0.184).ConclusionsA single episode of RIPC before elective PCI demonstrated less troponin elevation but failed to show a significant effect.

Long-term Results of One Cycle of Remote Ischemic Preconditioning Applied Before Elective Percutaneous Coronary Intervention

“…They implied that shorter time of RIPC could be an insufficient stimulant, resulting neutral outcome. Differently, Zografos et al, demonstrated reduced type 4a MI after elective PCI with one cycle of RIPC, whereas in our study we could not demonstrate a significant reduction (7,8) . Six year clinical outcomes of the patients enrolled in CRISP trial were also published and the results were coherent with the CRISP trial with lower MACE in the RIPC group (5,9) .…”

“…However, the best timing and protocol has not been determined yet. In one study, it has been demonstrated that one cycle of RIPC is also effective in reducing post-PCI myocardial injury, whereas in our study with a similar study population, we could not demonstrate cardioprotection with one cycle of RIPC (7)(8) . Most of the studies about RIPC evaluated myocardial injury by post-PCI cardiac enzyme elevation, there are a few studies with clinical endpoints.…”

“…This study was a single center randomized study and was approved by the local ethical committee and was registered to clinicaltrials.gov. The details and results of this study were published recently (8) . Patients with stable angina pectoris and undergoing elective PCI were randomized into two groups.…”

Remote ischaemic conditioning for myocardial infarction or elective PCI: systematic review and meta-analyses of randomised trials

“…Eleven trials reported cardiac troponin levels 16 hours 21–23 or 24 hours 24–31 after elective PCI. RIC was not associated with a reduction of cardiac biomarker release ( n =2048, SMD 0.06, 95% CI −0.17 to 0.30; P =0.59, I 2 =85%) with very high heterogeneity (Supplementary Appendix 6).…”