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Published on: May 28, 2019
Remote ischemic preconditioning improves outcome at 6 years after elective percutaneous coronary intervention: the
William R Davies1, Adam J Brown, William Watson
1Department of Interventional Cardiology, Papworth Hospital, Cambridge, United Kingdom.
Insights
Remote ischemic preconditioning significantly reduces major adverse cardiac and cerebral events (MACCE) after percutaneous coronary intervention (PCI). This protective effect, observed early, is sustained long-term, improving patient survival.
Area of Science:
- Cardiology
- Interventional Cardiology
- Ischemic Heart Disease
Background:
- Postprocedural myocardial infarction (type 4a) is a negative prognostic indicator following elective percutaneous coronary intervention (PCI).
- The CRISP Stent study showed remote ischemic preconditioning (RIP) reduced procedural complications and short-term MACCE after PCI.
- This study aimed to determine if the early MACCE benefit of RIP was sustained long-term.
Purpose of the Study:
- To evaluate the long-term efficacy of remote ischemic preconditioning (RIP) in reducing major adverse cardiac and cerebral events (MACCE) after elective percutaneous coronary intervention (PCI).
- To confirm the sustained benefit of RIP on patient outcomes beyond the initial 6-month follow-up.
Main Methods:
- Long-term follow-up data were collected from patients originally randomized in the CRISP Stent study.
- Major adverse cardiac and cerebral events (MACCE), defined as mortality, MI, stroke, or heart failure hospitalization, were adjudicated.
- Researchers blinded to randomization status contacted patients for data collection.
Main Results:
- Of 225 patients, 192 (89.3%) had long-term follow-up (mean 1579.7 days).
- The MACCE rate remained significantly lower in the RIP group (HR 0.58, P=0.039), with an absolute risk reduction of 13% and NNT of 8 at 6 years.
- Patients experiencing MACCE had higher post-PCI cardiac troponin I levels.
Conclusions:
- Remote ischemic preconditioning (RIP) effectively reduces postprocedural cardiac troponin I levels after elective PCI.
- RIP confers a sustained, long-term survival benefit, significantly reducing MACCE rates in patients undergoing elective PCI.
Background:
Postprocedural myocardial infarction (type 4a) has been shown to be an adverse prognostic indicator after elective percutaneous coronary intervention (PCI). The Cardiac Remote Ischemic Preconditioning in Coronary Stenting (CRISP Stent) study demonstrated that remote ischemic preconditioning reduced procedural symptoms, ECG ST-segment deviation, and cardiac troponin I release after elective PCI and reduced the major adverse cardiac and cerebral event (MACCE) rate at 6 months. We were interested to confirm if this early benefit in MACCE rate in the remote ischemic preconditioning group was sustained long-term.
Methods And Results:
Patients were telephoned by researchers blinded to the randomization details. MACCE, defined as all-cause mortality, nonfatal myocardial infarction, transient ischemic attack or stroke, and heart failure requiring hospital admission, were adjudicated by case note and national database review. One hundred ninety-two (89.3%) of the 225 patients with elective PCI randomized in the original study were available for long-term follow-up (mean time to event or last follow-up: 1579.7±603.6 days). There were a total of 59 (30.7%) MACCEs. Patients with an MACCE had a higher mean cardiac troponin I after PCI (±SD): 2.07±6.99 versus 0.91±2.07 ng/mL (P=0.05). The MACCE rate at 6 years remained lower in the remote ischemic preconditioning group (hazard ratio, 0.58; 95% confidence interval, 0.35-0.97; P=0.039; absolute risk reduction=0.13 and number needed to treat=8 to prevent the MACCE at 6 years).
Conclusions:
Remote ischemic preconditioning reduces the incidence of postprocedural cardiac troponin I after elective PCI and confers an MACCE-free survival benefit at both short- and long-term follow-up.
Clinical Trial Registration:
URL: http://www.ukcrn.org.uk. Unique identifier: UKCRN 4074.
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