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Remote ischemic postconditioning during percutaneous coronary interventions: remote ischemic
Shahar Lavi1, Sabrina D'Alfonso, Pantelis Diamantouros
1From the Western University (S.L., P.D., A.C., P.G., P.T., G.J., K.S., R.L.), London, Ontario, Canada; and London Health Sciences Centre (S.L., S.D., P.D., A.C., P.G., P.T., G.J., K.S., R.L.), London, Ontario, Canada.
Circulation. Cardiovascular Interventions
|April 3, 2014
Summary
Remote ischemic postconditioning (RIPost) applied during percutaneous coronary intervention (PCI) did not reduce myocardial injury. Inducing ischemia in the thigh or arm yielded similar protective effects in this study.
Area of Science:
- Cardiology
- Interventional Cardiology
- Ischemic Conditioning
Background:
- Remote ischemic preconditioning (RIPC) may reduce infarct size during percutaneous coronary intervention (PCI).
- The efficacy of remote ischemic postconditioning (RIPost) in preventing myocardial injury after PCI remains uncertain.
- Investigating whether conditioning a larger remote organ (thigh vs. arm) enhances myocardial protection is crucial.
Purpose of the Study:
- To evaluate the effectiveness of RIPost in reducing myocardial injury following PCI.
- To compare the protective effects of RIPost induced in the upper limb (arm) versus the lower limb (thigh).
Main Methods:
- A randomized controlled trial involving 360 patients undergoing PCI.
- Patients were assigned to three groups: RIPost via arm ischemia, RIPost via thigh ischemia, or a control group.
- RIPost involved three 5-minute cycles of limb occlusion immediately after stent deployment.
Main Results:
- The primary outcome (Troponin T >3×ULN post-PCI) occurred in 30% (arm), 35% (thigh), and 35% (control) of patients (P=0.64).
- No significant differences were observed in creatine kinase, high sensitivity C-reactive protein, or acute kidney injury incidence among the groups.
- RIPost did not demonstrate a reduction in periprocedural myocardial injury compared to the control group.
Conclusions:
- Remote ischemic postconditioning applied during PCI does not reduce periprocedural myocardial injury.
- The location of remote ischemia induction (arm vs. thigh) did not influence the protective effect of RIPost.
