Renal Protection Using Remote Ischemic Peri-Conditioning During Inter-Facility Helicopter Transport of Patients With ST-Segment Elevation Myocardial Infarction: A Retrospective Study.
OBJECTIVE
To assess the impact of remote ischemic peri-conditioning (RIPC) during inter-facility air medical transport of ST-segment elevation myocardial infarction (STEMI) patients on the incidence of acute kidney injury (AKI) following primary percutaneous coronary intervention (pPCI).


BACKGROUND
STEMI patients who receive pPCI have an increased risk of AKI for which there is no well-defined prophylactic therapy in the setting of emergent pPCI.


METHODS
Using the ACTION Registry-GWTG, we evaluated the impact of RIPC applied during inter-facility helicopter transport of STEMI patients from non-PCI capable hospitals to 2 PCI-hospitals in the United States between March, 2013 and September, 2015 on the incidence of AKI following pPCI. AKI was defined as ≥0.3 mg/dL increase in creatinine within 48-72 hours after pPCI.


RESULTS
Patients who received RIPC (n = 127), compared to those who did not (n = 92), were less likely to have AKI (11 of 127 patients [8.7%] vs. 17 of 92 patients [18.5%]; adjusted odds ratio = 0.32, 95% CI 0.12-0.85, P = 0.023) and all-cause in-hospital mortality (2 of 127 patients [1.6%] vs. 7 of 92 patients [7.6%]; adjusted odds ratio = 0.14, 95% CI 0.02-0.86, P = 0.034) after adjusting for socio-demographic and clinical characteristics. There was no difference in hospital length of stay (3 days [interquartile range, 2-4] vs. 3 days [interquartile range, 2-5], P = 0.357) between the 2 groups.


CONCLUSIONS
RIPC applied during inter-facility helicopter transport of STEMI patients for pPCI is associated with lower incidence of AKI and in-hospital mortality. The use of RIPC for renal protection in STEMI patients warrants further in depth investigation.
Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.|Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.|Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh, Pittsburgh, Pennsylvania.
Oladipupo
O
Olafiranye
Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Adetola
A
Ladejobi
Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Max
M
Wayne
Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Christian
C
Martin-Gill
Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Andrew D
AD
Althouse
Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Michael S
MS
Sharbaugh
Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Francis X
FX
Guyette
Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Steven E
SE
Reis
Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh, Pittsburgh, Pennsylvania.
John A
JA
Kellum
Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Catalin
C
Toma
D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D000368:Aged; D000401:Aircraft; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D019194:Ischemic Preconditioning / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010360:Patient Transfer / Q000379:methods*; D010414:Pennsylvania / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods; D012042:Registries; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000628:therapy; D013997:Time Factors