title: Ischemic preconditioning during coronary angioplasty is preserved in elderly patients.
abstract: BACKGROUND
  To establish whether the adaptation to ischemia observed in humans during percutaneous transluminal coronary angioplasty (PTCA) after repeated balloon inflations, i.e. a clinical correlate of ischemic preconditioning, is preserved in elderly patients.
  
  
  METHODS
  We studied 53 consecutive patients undergoing successful angioplasty for an isolated stenosis of a major epicardial coronary artery. On the basis of age, patients were separated into terciles: patients in the lower and middle terciles were grouped together (Group 1, adult patients, n = 24, mean age 50 +/- 6 years) and compared with those in the upper tercile (Group 2, elderly patients, n = 29, mean age 68 +/- 3 years). Intracoronary electrocardiogram was obtained at the end of the first two balloon inflations. Collateral recruitment during repeated balloon inflations was assessed by using an intracoronary Doppler guide wire (23 patients) or by using an intracoronary pressure guide wire (30 patients).
  
  
  RESULTS
  In Group 1, ST-segment changes during the second inflation were significantly less than those at the end of the first inflation (6 +/- 3 vs 13 +/- 5 mm, p < 0.001). Similarly, in Group 2, ST-segment changes during the second inflation were significantly less than those at the end of the first inflation (6 +/- 4 vs 13 +/- 6 mm, p < 0.001). In both groups, collateral recruitment did not change from the first inflation to the second inflation (p = 0.1).
  
  
  CONCLUSIONS
  Our study confirms that adaptation to ischemia during repeated balloon inflations in the setting of PTCA is independent of collateral recruitment and, therefore, is mainly due to ischemic preconditioning. More importantly, our study indicates that ischemic preconditioning is preserved in elderly patients.
authors.affiliation: Division of Cardiac Surgery, Tor Vergata University of Rome, Italy. f.tomai@tiscalinet.it
authors.forename: F
authors.initials: F
authors.lastname: Tomai
authors.forename: F
authors.initials: F
authors.lastname: Crea
authors.forename: A S
authors.initials: AS
authors.lastname: Ghini
authors.forename: I
authors.initials: I
authors.lastname: Proietti
authors.forename: A
authors.initials: A
authors.lastname: Gaspardone
authors.forename: F
authors.initials: F
authors.lastname: Versaci
authors.forename: R
authors.initials: R
authors.lastname: De Paulis
authors.forename: L
authors.initials: L
authors.lastname: Chiariello
authors.forename: P A
authors.initials: PA
authors.lastname: Gioffrè
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001783:Blood Flow Velocity; D003097:Collateral Circulation; D003326:Coronary Circulation / Q000502:physiology*; D003327:Coronary Disease / Q000503:physiopathology / Q000628:therapy*; D003331:Coronary Vessels / Q000502:physiology; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial; D008875:Middle Aged