title: Effect of remote ischemia or nicorandil on myocardial injury following percutaneous coronary intervention in patients with stable coronary artery disease: A randomized controlled trial.
abstract: BACKGROUND
  The effect of remote ischemic preconditioning (RIPC) and nicorandil on periprocedural myocardial injury (pMI) in patients with planned percutaneous coronary intervention (PCI) remains controversial. The aim of this randomized trial was to evaluate the effect of RIPC or nicorandil on pMI following PCI in patients with stable coronary artery disease (CAD) compared with a control group.
  
  
  METHODS
  Patients with stable CAD who planned to undergo PCI were assigned to a 1:1:1 ratio to control, RIPC, or intravenous nicorandil (6mg/h). Automated RIPC was performed by a device, which performs intermittent arm ischemia through three cycles of 5min of inflation and 5min of deflation of a pressure cuff. The primary outcome was the incidence of pMI, determined by an elevation in high-sensitive troponin T or creatine kinase myocardial band at 12 or 24h after PCI. The secondary outcomes were ischemic events during PCI and adverse clinical events at 8months after PCI.
  
  
  RESULTS
  A total of 391 patients were enrolled. The incidence of pMI following PCI was not significantly different between the control group (48.9%) and RIPC group (39.5%; p=0.14), or between the control group and nicorandil group (40.3%; p=0.17). There were no significant differences in ischemic events during PCI or adverse clinical events within 8months after PCI among the three groups.
  
  
  CONCLUSIONS
  This study demonstrated moderate reductions in biomarker release and pMI by RIPC or intravenous nicorandil prior to the PCI consistently, but may have failed to achieve statistical significance because the study was underpowered.
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences, Okayama, Japan. Electronic address: miyoshit@cc.okayama-u.ac.jp.
authors.forename: Toru
authors.initials: T
authors.lastname: Miyoshi
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Ejiri
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Kunihisa
authors.initials: K
authors.lastname: Kohno
authors.affiliation: Department of Cardiology, Fukuyama City Hospital, Hiroshima, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Nakahama
authors.affiliation: Department of Cardiology, Kagawa Prefectural Central Hospital, Kagawa, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Doi
authors.affiliation: Department of Cardiology, Okayama Medical Center, Okayama, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Munemasa
authors.affiliation: Department of Cardiology, Okayama Heart Clinic, Okayama, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Murakami
authors.affiliation: Department of Cardiology, Mitoyo General Hospital, Kagawa, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takaishi
authors.affiliation: Department of Cardiology, Okayama City General Medical Center, Okayama, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kawai
authors.affiliation: Department of Cardiology, Japanese Red Cross Okayama Hospital, Okayama, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Sato
authors.affiliation: Department of Cardiology, Fukuyama Cardiovascular Hospital, Hiroshima, Japan.
authors.forename: Katsumasa
authors.initials: K
authors.lastname: Sato
authors.affiliation: Department of Cardiology, Tsuyama chuo Hospital, Okayama, Japan.
authors.forename: Takefumi
authors.initials: T
authors.lastname: Oka
authors.affiliation: Department of Cardiology, Matsuyama Shimin Hospital, Ehime, Japan.
authors.forename: Natsuki
authors.initials: N
authors.lastname: Takahashi
authors.affiliation: Department of Cardiology, Iwakuni Medical Center, Yamaguchi, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Sakuragi
authors.affiliation: Department of Cardiology, Saiseikai Imabari Hospital, Ehime, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Mima
authors.affiliation: Department of Cardiology, Onomichi Municipal Hospital, Hiroshima, Japan.
authors.forename: Kenki
authors.initials: K
authors.lastname: Enko
authors.affiliation: Department of Cardiology, Kochi Medical Center, Kochi, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Hosogi
authors.affiliation: Department of Cardiology, Okayama Rosai Hospital, Okayama, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Nanba
authors.affiliation: Department of Cardiology, Japanese Red Cross Himeji Hospital, Hyogo, Japan.
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Hirami
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Nakamura
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000032:analysis; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000601:surgery*; D052279:Creatine Kinase, MB Form / Q000032:analysis; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000517:prevention & control; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D020108:Nicorandil / Q000008:administration & dosage*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control; D016896:Treatment Outcome; D020107:Troponin T / Q000032:analysis; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D015415:Biomarkers; D020107:Troponin T; D014665:Vasodilator Agents; D020108:Nicorandil; D052279:Creatine Kinase, MB Form
keywords: Complication; Percutaneous coronary intervention; Preconditioning