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Updated: Apr 20, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Remote ischemic preconditioning reduces contrast-induced acute kidney injury in patients with ST-elevation myocardial
Toshiaki Yamanaka1, Yusuke Kawai2, Toru Miyoshi3
1Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama 700-8558, Japan.
Insights
Remote ischemic preconditioning (RIPC) significantly reduced contrast medium-induced acute kidney injury (CI-AKI) in ST-elevation myocardial infarction patients undergoing emergency percutaneous coronary intervention. This protective effect was observed in the RIPC group compared to controls.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Contrast medium-induced acute kidney injury (CI-AKI) is a known complication following emergency percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI).
- Effective strategies to mitigate CI-AKI are crucial for improving patient outcomes after primary PCI.
Purpose of the Study:
- To evaluate the efficacy of remote ischemic preconditioning (RIPC) in preventing CI-AKI.
- To assess the impact of RIPC on CI-AKI incidence in STEMI patients undergoing emergency primary PCI.
Main Methods:
- A randomized, sham-controlled trial design was employed.
- Patients with suspected STEMI were randomized to receive PCI with or without RIPC (3 cycles of 5-min arm ischemia).
- CI-AKI was defined as a serum creatinine increase >0.5mg/dL or >25% within 48-72 hours post-contrast administration.
Main Results:
- The incidence of CI-AKI was significantly lower in the RIPC group (10%) compared to the control group (36%) (p=0.003).
- RIPC demonstrated a protective effect, with an odds ratio of 0.18 for CI-AKI (95% CI: 0.05-0.64; p=0.008).
- A total of 47 patients in the RIPC group and 47 in the control group met study criteria.
Conclusions:
- Remote ischemic preconditioning is an effective strategy to reduce the incidence of CI-AKI.
- RIPC should be considered as a protective measure for STEMI patients undergoing emergency PCI.
Background:
Contrast medium-induced acute kidney injury (CI-AKI) is a cardiovascular complication after myocardial infarction treated with emergency percutaneous coronary intervention. The aim of this randomized, sham-controlled trial was to evaluate the impact of remote ischemic preconditioning (RIPC) on CI-AKI in patients with ST-elevation myocardial infarction who received emergency primary percutaneous coronary intervention.
Methods And Results:
Patients with a suspected ST-elevation myocardial infarction were randomly assigned at a 1:1 ratio to receive percutaneous coronary intervention either with (n=63) or without (n=62) RIPC (intermittent arm ischemia through three cycles of 5min of inflation and 5min of deflation of a blood pressure cuff). A total of 47 RIPC patients and 47 control patients met all study criteria. The primary endpoint was the incidence of CI-AKI, which was defined as an increase in serum creatinine >0.5mg/dL or >25% over the baseline value 48-72h after administration of contrast medium. The incidence of CI-AKI was 10% (n=5) in the RIPC group and 36% (n=17) in the control group (p=0.003). The odds ratio of CI-AKI in patients who received RIPC was 0.18 (95% confidence interval: 0.05-0.64; p=0.008).
Conclusions:
In patients with ST-elevation myocardial infarction, RIPC before percutaneous coronary intervention reduced the incidence of CI-AKI.
