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Published on: May 28, 2019
Effect of one-cycle remote ischemic preconditioning to reduce myocardial injury during percutaneous coronary
Theodoros A Zografos1, George D Katritsis2, Ioannis Tsiafoutis3
1First Department of Cardiology, Athens Red Cross Hospital, Athens, Greece; Department of Cardiology, Athens Euroclinic, Athens, Greece.
Insights
A brief remote ischemic preconditioning (IPC) protocol significantly reduced cardiac troponin I release and myocardial infarction incidence following percutaneous coronary intervention (PCI). This simple intervention offers effective cardioprotection during PCI procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Ischemic Heart Disease
Background:
- Percutaneous coronary interventions (PCIs) are frequently complicated by troponin release.
- Remote ischemic preconditioning (IPC) offers cardioprotection, but lengthy protocols are impractical for ad hoc PCI.
- A need exists for brief IPC methods applicable during PCI.
Purpose of the Study:
- To evaluate the efficacy of a brief remote IPC protocol in reducing cardiac troponin I (cTnI) release after ad hoc PCI.
- To assess the impact of remote IPC on the incidence of PCI-related myocardial infarction (MI).
Main Methods:
- Ninety-four patients undergoing ad hoc PCI for stable coronary artery disease were randomized.
- The intervention group received one 5-minute remote IPC cycle (200 mm Hg cuff inflation).
- Cardiac troponin I (cTnI) levels were measured pre-PCI and 24 hours post-PCI to determine ΔcTnI.
Main Results:
- Remote IPC significantly reduced ΔcTnI compared to the control group (0.04 vs 0.19 ng/ml, p <0.001).
- The incidence of PCI-related myocardial infarction (MI) was significantly lower in the remote IPC group (19.1% vs 42.6%, p = 0.014).
- Multivariate analysis confirmed remote IPC's independent association with reduced ΔcTnI and PCI-related MI.
Conclusions:
- A single, brief remote IPC cycle immediately before ad hoc PCI effectively attenuates periprocedural cTnI release.
- This protocol reduces the incidence of type 4a MI, demonstrating its clinical utility.
- Brief remote IPC is a feasible and effective strategy for cardioprotection during PCI.
Abstract:
Up to 1/3 of percutaneous coronary interventions (PCIs) are complicated by troponin release. Remote ischemic preconditioning (IPC) confers effective cardioprotection; however, a 30-minute remote IPC protocol may be difficult to implement during ad hoc PCI. This study was performed to assess the ability of a brief remote IPC protocol to attenuate cardiac troponin I (cTnI) release after ad hoc PCI. Ninety-four patients undergoing ad hoc PCI for stable coronary artery disease, with undetectable preprocedural cTnI, were recruited and randomized to receive remote IPC (induced by one 5-minute inflation of a blood pressure cuff to 200 mm Hg around the upper arm) or control after the decision for PCI was made. The primary outcome was the difference between cTnI levels 24 hours after PCI and cTnI levels before coronary angiography (ΔcTnI). ΔcTnI in the remote IPC group was significantly lower compared with the control group (0.04 ng/ml [interquartile range 0.01 to 0.14] vs 0.19 ng/ml [interquartile range 0.18 to 0.59], p <0.001). The incidence of PCI-related myocardial infarction (MI) was greater in the control group (42.6% vs 19.1%, p = 0.014). In multivariate analysis, remote IPC was independently associated with ΔcTnI and PCI-related MI. In conclusion, our results suggest that even 1 cycle of remote IPC immediately before ad hoc PCI attenuates periprocedural cTnI release and reduces the incidence of type 4a MI.
