title: Remote ischemic preconditioning and endothelial function in patients with acute myocardial infarction and primary PCI.
abstract: BACKGROUND
  Remote ischemic preconditioning by transient limb ischemia reduces myocardial ischemia-reperfusion injury in patients undergoing percutaneous coronary intervention. The aim of the study we report here was to assess the effect of remote ischemic preconditioning on endothelial function in patients with acute myocardial infarction who underwent primary percutaneous coronary intervention.
  
  
  METHODS
  Forty-eight patients with acute myocardial infarction were enrolled. All participants were randomly divided into 2 groups. In Group I (n = 23), remote ischemic preconditioning was performed before primary percutaneous coronary intervention (intermittent arm ischemia-reperfusion through 4 cycles of 5-minute inflation and 5-minute deflation of a blood-pressure cuff to 200 mm Hg). In Group II (n = 25), standard percutaneous coronary intervention without preconditioning was performed. We assessed endothelial function using the flow-mediated dilation test on baseline, then within 1-3 hours after percutaneous coronary intervention, and again on days 2 and 7 after percutaneous coronary intervention.
  
  
  RESULTS
  The brachial artery flow-mediated dilation results were significantly higher on the first day after primary percutaneous coronary intervention in the preconditioning group (Group I) than in the control group (Group II) (12.1% vs 0.0%, P = .03, and 11.1% vs 6.3%, P = .016, respectively), and this difference remained on the seventh day (12.3% vs 7.4%, P = .0005, respectively).
  
  
  CONCLUSIONS
  We demonstrated for the first time that remote ischemic preconditioning before primary percutaneous coronary intervention significantly improves endothelial function in patients with acute myocardial infarction, and this effect remains constant for at least a week. We suppose that the improvement of endothelial function may be one of the possible explanations of the effect of remote ischemic preconditioning.
authors.affiliation: Department of Cardiology, Moscow State University of Medicine and Dentistry, Moscow, Russia.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Manchurov
authors.affiliation: Department of Cardiology, Moscow State University of Medicine and Dentistry, Moscow, Russia.
authors.forename: Nadezda
authors.initials: N
authors.lastname: Ryazankina
authors.affiliation: Department of Cardiology, Moscow State University of Medicine and Dentistry, Moscow, Russia.
authors.forename: Tatyana
authors.initials: T
authors.lastname: Khmara
authors.affiliation: Department of Cardiology, Moscow State University of Medicine and Dentistry, Moscow, Russia.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Skrypnik
authors.affiliation: Department of Cardiology, Moscow State University of Medicine and Dentistry, Moscow, Russia.
authors.forename: Roman
authors.initials: R
authors.lastname: Reztsov
authors.affiliation: Department of Cardiology, Moscow State University of Medicine and Dentistry, Moscow, Russia. Electronic address: vasilieva.helena@gmail.com.
authors.forename: Elena
authors.initials: E
authors.lastname: Vasilieva
authors.affiliation: Department of Cardiology, Moscow State University of Medicine and Dentistry, Moscow, Russia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Shpektor
mesh_terms: D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology* / Q000628:therapy*; D062645:Percutaneous Coronary Intervention
keywords: Acute myocardial infarction; Endothelial function; Flow-mediated dilation test; Remote ischemic preconditioning