title: The RIPOST-MI study, assessing remote ischemic perconditioning alone or in combination with local ischemic postconditioning in ST-segment elevation myocardial infarction.
abstract: Local ischemic postconditioning (IPost) and remote ischemic perconditioning (RIPer) are promising cardioprotective therapies in ST-elevation myocardial infarction (STEMI). We aimed: (1) to investigate whether RIPer initiated at the catheterization laboratory would reduce infarct size, as measured using serum creatine kinase-MB isoenzyme (CK-MB) release as a surrogate marker; (2) to assess if the combination of RIPer and IPost would provide an additional reduction. Patients (n = 151) were randomly allocated to one of the following groups: (1) control group, percutaneous transluminal coronary angioplasty (PTCA) alone; (2) RIPer group, PTCA combined with RIPer, consisting of three cycles of 5-min inflation and 5-min deflation of an upper-arm blood-pressure cuff initiated before reperfusion; (3) RIPer+IPost group, PTCA combined with RIPer and IPost, consisting of four cycles of 1-min inflation and 1-min deflation of the angioplasty balloon. The CK-MB area under the curve (AUC) over 72 h was reduced in RIPer, and RIPer+IPost groups, by 31 and 29 %, respectively, compared to the Control group; however, CK-MB AUC differences between the three groups were not statistically significant (p = 0.06). Peak CK-MB, CK-MB AUC to area at risk (AAR) ratio, and peak CK-MB level to AAR ratio were all significantly reduced in the RIPer and RIPer+IPost groups, compared to the Control group. On the contrary, none of these parameters was significantly different between RIPer+IPost and RIPer groups. To conclude, starting RIPer therapy immediately prior to revascularization was shown to reduce infarct size in STEMI patients, yet combining this therapy with an IPost strategy did not lead to further decrease in infarct size.
authors.affiliation: Service de Cardiologie, EA 3860, Laboratoire Cardioprotection, Remodelage et Thrombose, Université Angers, CHU Angers, rue Haute de Reculée, 49045, Angers, France, faprunier@chu-angers.fr.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Prunier
authors.forename: Denis
authors.initials: D
authors.lastname: Angoulvant
authors.forename: Christophe
authors.initials: C
authors.lastname: Saint Etienne
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Vermes
authors.forename: Martine
authors.initials: M
authors.lastname: Gilard
authors.forename: Christophe
authors.initials: C
authors.lastname: Piot
authors.forename: François
authors.initials: F
authors.lastname: Roubille
authors.forename: Meyer
authors.initials: M
authors.lastname: Elbaz
authors.forename: Michel
authors.initials: M
authors.lastname: Ovize
authors.forename: Loïc
authors.initials: L
authors.lastname: Bière
authors.forename: Julien
authors.initials: J
authors.lastname: Jeanneteau
authors.forename: Stéphane
authors.initials: S
authors.lastname: Delépine
authors.forename: Thomas
authors.initials: T
authors.lastname: Benard
authors.forename: Wissam
authors.initials: W
authors.lastname: Abi-Khalil
authors.forename: Alain
authors.initials: A
authors.lastname: Furber
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015415:Biomarkers / Q000097:blood; D002316:Cardiotonic Agents; D052279:Creatine Kinase, MB Form / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006801:Humans; D057775:Ischemic Postconditioning / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D015428:Myocardial Reperfusion Injury / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D002316:Cardiotonic Agents; D052279:Creatine Kinase, MB Form