The RIPOST-MI study, assessing remote ischemic perconditioning alone or in combination with local ischemic postconditioning in ST-segment elevation myocardial infarction

• Published in: Basic research in cardiology Vol. 109; no. 2; p. 400
• Main Authors: Prunier, Fabrice, Angoulvant, Denis, Saint Etienne, Christophe, Vermes, Emmanuelle, Gilard, Martine, Piot, Christophe, Roubille, François, Elbaz, Meyer, Ovize, Michel, Bière, Loïc, Jeanneteau, Julien, Delépine, Stéphane, Benard, Thomas, Abi-Khalil, Wissam, Furber, Alain
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.03.2014; Springer Nature B.V; Springer Verlag
• Subjects: Aged; Aged, 80 and over; Algorithms; Biomarkers - blood; Cardiology; Cardiotonic Agents; Creatine Kinase, MB Form - blood; Electrocardiography; Female; Humans; Ischemic Postconditioning - methods; Life Sciences; Male; Medicine; Medicine & Public Health; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - therapy; Myocardial Reperfusion Injury - therapy; Original Contribution; Percutaneous Coronary Intervention - methods; Prospective Studies; Treatment Outcome; Remote conditioning; Reperfusion injury; Cardioprotection; methods""Prospective Studies""Treatment Outcome; therapy""Myocardial Reperfusion Injury; MB Form/blood""Electrocardiography""Female""Humans""Ischemic Postconditioning/methods""Male""Middle Aged""Myocardial Infarction/diagnosis/therapy""Myocardial Reperfusion Injury/therapy""Percutaneous Coronary Intervention/methods""Prospective Studies""Treatment Outcome; diagnosis; 80 and over""Algorithms""Biological Markers/blood""Cardiotonic Agents""Creatine Kinase; methods""Male""Middle Aged""Myocardial Infarction; therapy""Percutaneous Coronary Intervention; blood""Electrocardiography""Female""Humans""Ischemic Postconditioning; MB Form; Aged""Aged
• ISSN: 0300-8428; 1435-1803
• DOI: 10.1007/s00395-013-0400-y

Local ischemic postconditioning (IPost) and remote ischemic perconditioning (RIPer) are promising cardioprotective therapies in ST-elevation myocardial infarction (STEMI). We aimed: (1) to investigate whether RIPer initiated at the catheterization laboratory would reduce infarct size, as measured using serum creatine kinase-MB isoenzyme (CK-MB) release as a surrogate marker; (2) to assess if the combination of RIPer and IPost would provide an additional reduction. Patients ( n  = 151) were randomly allocated to one of the following groups: (1) control group, percutaneous transluminal coronary angioplasty (PTCA) alone; (2) RIPer group, PTCA combined with RIPer, consisting of three cycles of 5-min inflation and 5-min deflation of an upper-arm blood-pressure cuff initiated before reperfusion; (3) RIPer+IPost group, PTCA combined with RIPer and IPost, consisting of four cycles of 1-min inflation and 1-min deflation of the angioplasty balloon. The CK-MB area under the curve (AUC) over 72 h was reduced in RIPer, and RIPer+IPost groups, by 31 and 29 %, respectively, compared to the Control group; however, CK-MB AUC differences between the three groups were not statistically significant ( p  = 0.06). Peak CK-MB, CK-MB AUC to area at risk (AAR) ratio, and peak CK-MB level to AAR ratio were all significantly reduced in the RIPer and RIPer+IPost groups, compared to the Control group. On the contrary, none of these parameters was significantly different between RIPer+IPost and RIPer groups. To conclude, starting RIPer therapy immediately prior to revascularization was shown to reduce infarct size in STEMI patients, yet combining this therapy with an IPost strategy did not lead to further decrease in infarct size.