title: Remote ischemic preconditioning immediately before percutaneous coronary intervention does not impact myocardial necrosis, inflammatory response, and circulating endothelial progenitor cell counts: a single center randomized sham controlled trial.
abstract: OBJECTIVE
  Percutaneous coronary intervention (PCI) is frequently accompanied by myocardial injury. The present study was performed to determine whether remote ischemic preconditioning (IP) induces cardioprotection during PCI.
  
  
  METHODS
  We enrolled 95 patients requiring nonemergency PCI for stable disease or unstable angina into this prospective clinical trial. Patients were randomized to either remote IP (induced by three 3-min cycles of blood pressure cuff inflations to 200 mm Hg around the upper arm, followed by 3-min of reperfusion n = 47) or sham control (n = 48) immediately preceding PCI. The primary outcome measure was the frequency of post-PCI myonecrosis, defined as a peak postprocedural cTnT T ≥ 0.03 ng/dL. Secondary outcome measures were the change in plasma high-sensitivity C-reactive protein (hsCRP) levels following PCI and in endothelial progenitor cells (EPC) counts following IP.
  
  
  RESULTS
  There was no difference in the primary endpoint of the frequency of PCI related myonecrosis which occurred in 22 (47%) and 19 (40%) patients in the remote IP and control groups, respectively, P = 0.42. There was significant increase in hsCRP post-PCI in both groups (P < 0.001), but there was no difference between the groups (median %change in hsCRP 46% vs. 54%, P = 0.73). There was no significant change in circulating early (CD34 -/CD133+/KDR+), intermediate (CD34+/CD133+/KDR+), or late (CD34+/CD133-/KDR+) EPC in the two groups immediately following IP. The composite rate of death, myocardial infarction, and target lesion revascularization at 1 year was 14.1% versus 13.7% (P = 0.90).
  
  
  CONCLUSIONS
  Our study indicates that remote IP immediately before PCI does not induce cardioprotection in low to moderate risk patients.
authors.affiliation: Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA. prasad.abhiram@mayo.edu
authors.forename: Abhiram
authors.initials: A
authors.lastname: Prasad
authors.forename: Mario
authors.initials: M
authors.lastname: Gössl
authors.forename: John
authors.initials: J
authors.lastname: Hoyt
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Lennon
authors.forename: Lynn
authors.initials: L
authors.lastname: Polk
authors.forename: Robert
authors.initials: R
authors.lastname: Simari
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
authors.forename: Amir
authors.initials: A
authors.lastname: Lerman
mesh_terms: D000071916:AC133 Antigen; D000368:Aged; D060050:Angina, Stable / Q000097:blood / Q000473:pathology / Q000628:therapy; D000789:Angina, Unstable / Q000097:blood / Q000473:pathology / Q000628:therapy; D015703:Antigens, CD / Q000097:blood; D018952:Antigens, CD34 / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002452:Cell Count; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000097:blood / Q000473:pathology / Q000628:therapy*; D042783:Endothelial Cells / Q000378:metabolism / Q000473:pathology*; D005260:Female; D006023:Glycoproteins / Q000097:blood; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology*; D018836:Inflammation Mediators / Q000097:blood; D019194:Ischemic Preconditioning / Q000379:methods*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D009206:Myocardium / Q000378:metabolism / Q000473:pathology*; D009336:Necrosis; D010455:Peptides / Q000097:blood; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011446:Prospective Studies; D012307:Risk Factors; D013234:Stem Cells / Q000378:metabolism / Q000473:pathology*; D013997:Time Factors; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood; D034941:Upper Extremity / Q000098:blood supply*; D040301:Vascular Endothelial Growth Factor Receptor-2 / Q000097:blood
chemical_list: D000071916:AC133 Antigen; D015703:Antigens, CD; D018952:Antigens, CD34; D015415:Biomarkers; D006023:Glycoproteins; D018836:Inflammation Mediators; C000606023:PROM1 protein, human; D010455:Peptides; D020107:Troponin T; D002097:C-Reactive Protein; D040301:Vascular Endothelial Growth Factor Receptor-2