Cardiac Remote Ischemic Preconditioning in Coronary Stenting (CRISP Stent) Study: a prospective, randomized control trial.
BACKGROUND
Myocyte necrosis as a result of elective percutaneous coronary intervention (PCI) occurs in approximately one third of cases and is associated with subsequent cardiovascular events. This study assessed the ability of remote ischemic preconditioning (IPC) to attenuate cardiac troponin I (cTnI) release after elective PCI.


RESULTS
Two hundred forty-two consecutive patients undergoing elective PCI with undetectable preprocedural cTnI were recruited. Subjects were randomized to receive remote IPC (induced by three 5-minute inflations of a blood pressure cuff to 200 mm Hg around the upper arm, followed by 5-minute intervals of reperfusion) or control (an uninflated cuff around the arm) before arrival in the catheter laboratory. The primary outcome was cTnI at 24 hours after PCI. Secondary outcomes included renal dysfunction and major adverse cardiac and cerebral event rate at 6 months. The median cTnI at 24 hours after PCI was lower in the remote IPC compared with the control group (0.06 versus 0.16 ng/mL; P=0.040). After remote IPC, cTnI was <0.04 ng/mL in 44 patients (42%) compared with 24 in the control group (24%; P=0.01). Subjects who received remote IPC experienced less chest discomfort (P=0.0006) and ECG ST-segment deviation (P=0.005) than control subjects. At 6 months, the major adverse cardiac and cerebral event rate was lower in the remote IPC group (4 versus 13 events; P=0.018).


CONCLUSIONS
Remote IPC reduces ischemic chest discomfort during PCI, attenuates procedure-related cTnI release, and appears to reduce subsequent cardiovascular events.
Hoole
Stephen P
SP
Department of Cardiology, Papworth Hospital, Papworth Everard, UK.
Heck
Patrick M
PM
Sharples
Linda
L
Khan
Sadia N
SN
Duehmke
Rudolf
R
Densem
Cameron G
CG
Clarke
Sarah C
SC
Shapiro
Leonard M
LM
Schofield
Peter M
PM
O'Sullivan
Michael
M
Dutka
David P
DP
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006331:Heart Diseases / Q000209:etiology; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015607:Stents; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome; D019210:Troponin I / Q000032:analysis
D019210:Troponin I