title: Remote ischemic preconditioning stimulus does not reduce microvascular resistance or improve myocardial blood flow in patients undergoing elective percutaneous coronary intervention.
abstract: BACKGROUND
  Remote ischemic preconditioning (RIPC) may limit myocardial infarction by improving microvascular function and maintaining myocardial blood flow. We hypothesized that a RIPC stimulus would reduce coronary microvascular resistance and improve coronary blood flow during elective percutaneous coronary intervention (PCI).
  
  
  METHODS
  We prospectively recruited 54 patients with multi-vessel disease (MVD = 32) or single vessel disease awaiting elective PCI. Patients with MVD had non-target vessel (NTV) index of micro-circulatory resistance (IMR) determined, before and after target vessel (TV) PCI (cardiac RIPC). The effect of arm RIPC on serial microvascular resistance (R(p)) was assessed in patients with single vessel disease.
  
  
  RESULTS
  TV balloon occlusion did not alter the NTV IMR: 16.5 (12.4) baseline vs. 17.6 (11.6) post cardiac RIPC, P = 0.65 or hyperaemic transit time. Arm RIPC did not alter R( p) in patients with single vessel disease: Rp, mmHg.cm(-1).s( -1): 3.5 (1.9) baseline vs. 4.1 (3.0) post arm RIPC, P = 0.19 and coronary flow velocity remained constant.
  
  
  CONCLUSIONS
  RIPC stimuli during elective PCI do not affect coronary microvascular resistance or coronary flow in humans.
authors.affiliation: Department of Cardiovascular Medicine, Addenbrooke's Hospital, Hills Rd, Cambridge CB2 0QQ, United Kingdom.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Hoole
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Heck
authors.forename: Paul A
authors.initials: PA
authors.lastname: White
authors.forename: Sadia N
authors.initials: SN
authors.lastname: Khan
authors.forename: Michael
authors.initials: M
authors.lastname: O'Sullivan
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Clarke
authors.forename: David P
authors.initials: DP
authors.lastname: Dutka
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D001132:Arm / Q000098:blood supply*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D003326:Coronary Circulation; D005260:Female; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods*; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D011446:Prospective Studies; D011859:Radiography; D012720:Severity of Illness Index; D014111:Tourniquets; D016896:Treatment Outcome; D014655:Vascular Resistance