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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Efficacy of comprehensive remote ischemic conditioning in elderly patients with acute ST-segment elevation myocardial
Yan-Ling Wang1, Qi Yang2, Cheng-Yan Hu1
1Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Insights
Comprehensive remote ischemic conditioning (RIC) improved myocardial salvage index, quality of life, and exercise capacity in elderly STEMI patients undergoing primary percutaneous coronary intervention (PPCI). RIC may be a beneficial adjunctive therapy.
Area of Science:
- Cardiology
- Ischemic Heart Disease
- Geriatric Medicine
Background:
- Remote ischemic conditioning (RIC) is a protective strategy against myocardial injury.
- Evidence for comprehensive RIC in elderly ST-segment elevation myocardial infarction (STEMI) patients is limited.
- This study investigated the efficacy of comprehensive RIC in this population.
Purpose of the Study:
- To evaluate the impact of comprehensive RIC on myocardial salvage index (SI), left ventricular ejection fraction (LVEF), and quality of life in elderly STEMI patients.
- To assess the effect of RIC on 6-minute walk test distance (6MWD) and adverse events.
- To determine if RIC improves clinical outcomes up to 12 months post-primary percutaneous coronary intervention (PPCI).
Main Methods:
- 328 elderly STEMI patients were randomized to standard PPCI with or without comprehensive RIC.
- RIC was administered pre-PPCI and daily for 1-30 days post-PPCI.
- Key outcomes including SI, LVEF, LVEDVI, LVESVI, KCCQ-CSS, 6MWD, and adverse events were assessed.
Main Results:
- The RIC group showed a significantly higher SI (P=0.037).
- Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS) and 6-minute walk test distance (6MWD) were significantly improved in the RIC group at 1 and 12 months.
- LVEF tended to be higher and LVEDVI lower in the RIC group, though not statistically significant. No significant difference in major adverse events was observed.
Conclusions:
- Comprehensive RIC significantly improves SI, KCCQ-CSS, and 6MWD in elderly STEMI patients.
- RIC demonstrates potential as an adjunctive therapy to PPCI for improving outcomes in this patient group.
- Further research may elucidate long-term benefits and optimal RIC protocols.
Background:
Remote ischemic conditioning (RIC) is used to protect against myocardial injury. However, there is no adequate evidence for comprehensive RIC in elderly patients with ST-segment elevation myocardial infarction (STEMI). This study aimed to test whether comprehensive RIC, started pre-primary percutaneous coronary intervention (PPCI) and repeated daily on 1-30 days post-PPCI, can improve myocardial salvage index (SI), left ventricular ejection fraction (LVEF), Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS) and 6-min walk test distance (6MWD) in elderly patients with acute STEMI during 12 months follow-up.
Methods:
328 consenting elderly patients were randomized to receive standard PPCI plus comprehensive RIC (the treatment group) or standard PPCI (the control group). SI at 5-7 days after PPCI, LVEF, left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI), KCCQ-CSS, 6MWD and adverse events rates were measured and assessed.
Results:
SI was significantly higher in the treatment group [interquartile range (IQR): 0.38-0.66, P = 0.037]. There were no significant differences in major adverse events at 12 months. Although the differences of LVEDVI, LVESVI and LVEF between the treatment group and the control group did not reach statistical significance at 6 months and 12 months, LVEF tended to be higher, LVEDVI tended to be lower in the treatment group. The KCCQ-CSS was significantly higher in the treatment group at 1 month (IQR: 46.5-87, P = 0.001) and 12 months (IQR: 55-93, P = 0.008). There was significant difference in 6MWD between the treatment group and the control group (IQR: 258-360 vs. IQR: 250-345, P = 0.002) at 1 month and (IQR: 360-445 vs. IQR: 345-432, P = 0.035) at 12 months. A modest correlation was found between SI and LVEF (r = 0.452, P < 0.01), KCCQ-CSS ( r = 0.440, P < 0.01) and 6MWD ( r = 0.384, P < 0.01) respectively at 12 months.
Conclusions:
The comprehensive RIC can improve SI, KCCQ-CSS and 6MWD. It may be an adjunctive therapy to PPCI in elderly patients with STEMI.
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