title: Effect of one-cycle remote ischemic preconditioning to reduce myocardial injury during percutaneous coronary intervention.
abstract: Up to 1/3 of percutaneous coronary interventions (PCIs) are complicated by troponin release. Remote ischemic preconditioning (IPC) confers effective cardioprotection; however, a 30-minute remote IPC protocol may be difficult to implement during ad hoc PCI. This study was performed to assess the ability of a brief remote IPC protocol to attenuate cardiac troponin I (cTnI) release after ad hoc PCI. Ninety-four patients undergoing ad hoc PCI for stable coronary artery disease, with undetectable preprocedural cTnI, were recruited and randomized to receive remote IPC (induced by one 5-minute inflation of a blood pressure cuff to 200 mm Hg around the upper arm) or control after the decision for PCI was made. The primary outcome was the difference between cTnI levels 24 hours after PCI and cTnI levels before coronary angiography (ΔcTnI). ΔcTnI in the remote IPC group was significantly lower compared with the control group (0.04 ng/ml [interquartile range 0.01 to 0.14] vs 0.19 ng/ml [interquartile range 0.18 to 0.59], p <0.001). The incidence of PCI-related myocardial infarction (MI) was greater in the control group (42.6% vs 19.1%, p = 0.014). In multivariate analysis, remote IPC was independently associated with ΔcTnI and PCI-related MI. In conclusion, our results suggest that even 1 cycle of remote IPC immediately before ad hoc PCI attenuates periprocedural cTnI release and reduces the incidence of type 4a MI.
authors.affiliation: First Department of Cardiology, Athens Red Cross Hospital, Athens, Greece; Department of Cardiology, Athens Euroclinic, Athens, Greece.
authors.forename: Theodoros A
authors.initials: TA
authors.lastname: Zografos
authors.affiliation: Faculty of Medicine, University of Bristol, Bristol, United Kingdom.
authors.forename: George D
authors.initials: GD
authors.lastname: Katritsis
authors.affiliation: First Department of Cardiology, Athens Red Cross Hospital, Athens, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Tsiafoutis
authors.affiliation: First Department of Cardiology, Athens Red Cross Hospital, Athens, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Bourboulis
authors.affiliation: First Department of Cardiology, Athens Red Cross Hospital, Athens, Greece.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Katsivas
authors.affiliation: Department of Cardiology, Athens Euroclinic, Athens, Greece. Electronic address: dkatritsis@euroclinic.gr.
authors.forename: Demosthenes G
authors.initials: DG
authors.lastname: Katritsis
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000517:prevention & control*; D015428:Myocardial Reperfusion Injury / Q000097:blood / Q000517:prevention & control*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods; D010865:Pilot Projects; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D019210:Troponin I / Q000032:analysis / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I