title: Association of remote ischemic peri-conditioning with reduced incidence of clinical heart failure after primary percutaneous coronary intervention.
abstract: BACKGROUND
  Clinical heart failure (HF) occurs frequently after ST-segment elevation myocardial infarction (STEMI), and is associated with increased mortality. We assessed the impact of remote ischemic peri-conditioning (RIPC) during inter-facility air medical transport of STEMI patients on clinical HF following primary percutaneous coronary intervention (pPCI).
  
  
  METHODS
  Data from Acute Coronary Treatment and Intervention Outcomes Network Registry®-Get With the Guidelines™ (ACTION Registry-GWTG) from two PCI-hospitals that are utilizing RIPC during inter-facility helicopter transport of STEMI patients for pPCI between March, 2013 and September, 2015 were used for this study. The analyses were limited to inter-facility STEMI patients transported by helicopter with LVEF <55% after pPCI. The outcome measures were occurrence of clinical HF and serum level of brain-type natriuretic peptide (BNP).
  
  
  RESULTS
  Out of the 150 STEMI patients in this analysis, 92 patients received RIPC and 58 did not. The RIPC and non-RIPC groups were generally similar in demographic and clinical characteristics except for lower incidence of cardiac arrest in the RIPC group (3/92 [3.3%] versus 13/58 [22.4%], p=0.002). STEMI patients who received RIPC were less likely to have in-hospital clinical HF compared to patients who did not receive RIPC (3/92 [3.3%] versus 7/58 [12.1%]; adjusted OR=0.22, 95% CI 0.05-0.92, p=0.038) after adjusting for baseline differences. In subgroup analysis, RIPC was associated with lower BNP (123 [interquartile range, 17.0-310] versus 319 [interquartile range, 106-552], p=0.029).
  
  
  CONCLUSIONS
  RIPC applied during inter-facility air transport of STEMI patients for pPCI is associated with reduced incidence of clinical HF and serum BNP.
authors.affiliation: Department of Medicine, Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Adetola
authors.initials: A
authors.lastname: Ladejobi
authors.affiliation: Department of Medicine, Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Max
authors.initials: M
authors.lastname: Wayne
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Martin-Gill
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Francis X
authors.initials: FX
authors.lastname: Guyette
authors.affiliation: Department of Medicine, Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Althouse
authors.affiliation: Department of Medicine, Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Sharbaugh
authors.affiliation: Department of Medicine, Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Reis
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Clifton W
authors.initials: CW
authors.lastname: Callaway
authors.affiliation: Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Kellum
authors.affiliation: Department of Medicine, Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: A J Conrad
authors.initials: AJ
authors.lastname: Smith
authors.affiliation: Department of Medicine, Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Catalin
authors.initials: C
authors.lastname: Toma
authors.affiliation: Department of Medicine, Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: olafiranyeo@upmc.edu.
authors.forename: Oladipupo
authors.initials: O
authors.lastname: Olafiranye
mesh_terms: D000368:Aged; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006333:Heart Failure / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D019194:Ischemic Preconditioning; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000379:methods; D012042:Registries / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: Acute myocardial infarction; Brain-type natriuretic peptide; Heart failure; Remote ischemic conditioning