title: Remote ischemic preconditioning in percutaneous coronary revascularization: a double-blind randomized controlled clinical trial.
abstract: OBJECTIVE
  To assess the impact of pre-procedural remote ischemic preconditioning on the incidence of myocardial complications following percutaneous coronary intervention.
  
  
  BACKGROUND
  Ischemic preconditioning of a remote vascular territory improves the subsequent ischemic tolerance of distant organs.
  
  
  METHODS
  The Myocardial Event Reduction with Ischemic Preconditioning Therapy (MERIT) trial recruited 80 consecutive patients undergoing elective angioplasty with drug-eluting stents to receive two 5-min lower limb tourniquet occlusions or an un-inflated tourniquet (controls) 1 h before the procedure. The primary outcome was troponin T level at 24 h. Secondary outcomes were intra-procedural chest pain and ST-segment deviation.
  
  
  RESULTS
  6 patients in the control group and 2 in the ischemic preconditioning group had pre-procedural raised troponin T (p = 0.23). This increased to 16 (40%) in the control group and 5 (12.5%) in the study group at 24 h (p = 0.01). Fewer patients in the study group experienced intra-procedural chest pain (1 vs. 7, p = 0.056). Mean ST-segment deviation time was 13 ± 35 s in the study group and 58 ± 118 s in the control group (p = 0.02). At a mean follow-up of 11 months, the major adverse cardiac event rate did not differ significantly between the groups.
  
  
  CONCLUSIONS
  These data suggest that ischemic preconditioning reduces the absolute risk of post-procedure cardiomyocyte necrosis by 27.5%, and reduces intra-procedural chest pain and ST-segment deviation in patients undergoing percutaneous coronary interventions. We suggest its routine use in percutaneous coronary intervention, although the long-term prognostic impact in this patient group warrants further investigation.
authors.affiliation: Mazandaran Heart Institute, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Ghaemian
authors.forename: S Mahmoud
authors.initials: SM
authors.lastname: Nouraei
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Abdollahian
authors.forename: Farshad
authors.initials: F
authors.lastname: Naghshvar
authors.forename: Dino A
authors.initials: DA
authors.lastname: Giussani
authors.forename: S A Reza
authors.initials: SA
authors.lastname: Nouraei
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000209:etiology / Q000517:prevention & control; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D004311:Double-Blind Method; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007492:Iran; D019194:Ischemic Preconditioning / Q000295:instrumentation / Q000379:methods*; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D015428:Myocardial Reperfusion Injury / Q000209:etiology / Q000517:prevention & control; D012039:Regional Blood Flow; D012307:Risk Factors; D013997:Time Factors; D014111:Tourniquets; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D020107:Troponin T