title: Remote ischemic postconditioning during percutaneous coronary interventions: remote ischemic postconditioning-percutaneous coronary intervention randomized trial.
abstract: BACKGROUND
  Remote ischemic preconditioning may result in reduction in infarct size during percutaneous coronary intervention (PCI). It is unclear whether remote ischemic postconditioning (RIPost) will reduce the incidence of myocardial injury after PCI, and whether ischemic conditioning of a larger remote organ (thigh versus arm) would provide further myocardial protection.
  
  
  RESULTS
  We randomized 360 patients presenting with stable or unstable angina (28% of patients) and negative Troponin T at baseline to 3 groups: 2 groups received RIPost (induced by ischemia to upper or lower limb), and a third was the control group. RIPost was applied during PCI immediately after stent deployment, by three 5-minute cycles of blood pressure cuff inflation to >200 mm Hg in the arm or thigh (20 mm Hg in the control) with 5-minute breaks between each cycle. The primary end-point was the proportion of patients with Troponin T levels >3×ULN postprocedure (at 6 or 18-24 hours), where ULN stands for upper limit of normal. A total of 120 patients were randomized to each group. There were no differences in baseline characteristics between the 3 groups. The primary outcome occurred in 30%, 35%, and 35% of the arm, thigh, and control groups, respectively (P=0.64). There were no differences in creatine kinase or high sensitivity C-reactive protein levels after PCI or in the incidence of acute kidney injury between the groups.
  
  
  CONCLUSIONS
  RIPost during PCI did not reduce the incidence of periprocedural myocardial injury. Similar effect was obtained when remote ischemia was induced to the upper or lower limb.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT00970827.
authors.affiliation: From the Western University (S.L., P.D., A.C., P.G., P.T., G.J., K.S., R.L.), London, Ontario, Canada; and London Health Sciences Centre (S.L., S.D., P.D., A.C., P.G., P.T., G.J., K.S., R.L.), London, Ontario, Canada.
authors.forename: Shahar
authors.initials: S
authors.lastname: Lavi
authors.forename: Sabrina
authors.initials: S
authors.lastname: D'Alfonso
authors.forename: Pantelis
authors.initials: P
authors.lastname: Diamantouros
authors.forename: Anthony
authors.initials: A
authors.lastname: Camuglia
authors.forename: Pallav
authors.initials: P
authors.lastname: Garg
authors.forename: Patrick
authors.initials: P
authors.lastname: Teefy
authors.forename: George
authors.initials: G
authors.lastname: Jablonsky
authors.forename: Kumar
authors.initials: K
authors.lastname: Sridhar
authors.forename: Ronit
authors.initials: R
authors.lastname: Lavi
mesh_terms: D000368:Aged; D001132:Arm / Q000098:blood supply*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D015994:Incidence; D057775:Ischemic Postconditioning / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000473:pathology / Q000628:therapy*; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000473:pathology; D009206:Myocardium / Q000473:pathology; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D013848:Thigh / Q000098:blood supply*; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood
chemical_list: D020107:Troponin T
keywords: angioplasty; reperfusion injury