Effect of remote ischemic conditioning on infarct size in patients with anterior ST-elevation myocardial infarction.
BACKGROUND
Previous studies indicate that remote ischemic conditioning performed before percutaneous coronary intervention (PCI) reduces infarct size in patients with ST-elevation myocardial infarction (STEMI). It remains unclear whether remote conditioning affords protection when performed in adjunct to primary PCI. We aimed to study whether remote ischemic per-postconditioning (RIperpostC) initiated after admission to the catheterization laboratory attenuates myocardial infarct size in patients with anterior STEMI.


METHODS
In this prospective multicenter trial 93 patients with anterior STEMI were randomized to RIperpostC or sham procedure as adjunct to primary PCI. RIperpostC was started on arrival in the catheterization laboratory by 5-minute cycles of inflation and deflation of a blood pressure cuff around the left thigh and continued throughout the PCI procedure. Infarct size and myocardium at risk were determined by cardiac magnetic resonance at day 4 to 7. The primary outcome was myocardial salvage index.


RESULTS
There was no significant difference in myocardial salvage index between the RIperpostC and control group (median 48.5% and interquartile range 30.9%-60.8% vs 49.2% [42.1%-58.8%]). Neither did absolute infarct size in relation to left ventricular myocardial volume differ significantly (RIperpostC 20.6% [14.1%-31.7%] vs control 17.9% [13.4%-25.0%]). The RIperpostC group had larger myocardial area at risk than the control group (43.1% (35.4%-49.7%) vs 37.0% (30.8%-44.1%) of the left ventricle, P=.03). Peak value and area under the curve for troponin T did not differ significantly between the study groups.


CONCLUSIONS
RIperpostC initiated after admission to the catheterization laboratory in patients with anterior STEMI did not confer protection against reperfusion injury.
Department of Medicine, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital. Electronic address: dinos.verouhis@karolinska.se.
Dinos
D
Verouhis
Department of Medicine, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital.
Peder
P
Sörensson
Department of Medicine, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital; Research Centre Cardiology, Minsk, Belarus.
Andrey
A
Gourine
Department of Medicine, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital.
Loghman
L
Henareh
Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital.
Jonas
J
Persson
Department of Medicine, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital.
Nawzad
N
Saleh
Department of Medicine, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital.
Magnus
M
Settergren
Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
Martin
M
Sundqvist
Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
Per
P
Tornvall
Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
Nils
N
Witt
Department of Medicine, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital.
Felix
F
Böhm
Department of Medicine, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital.
John
J
Pernow
D000368:Aged; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D057775:Ischemic Postconditioning / Q000379:methods*; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000000981:diagnostic imaging / Q000517:prevention & control*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D000072657:ST Elevation Myocardial Infarction / Q000097:blood / Q000000981:diagnostic imaging / Q000628:therapy*; D012720:Severity of Illness Index; D020107:Troponin T / Q000097:blood
D020107:Troponin T