Effect of remote ischemic conditioning on infarct size in patients with anterior ST-elevation myocardial infarction

• Published in: The American heart journal Vol. 181; pp. 66 - 73
• Main Authors: Verouhis, Dinos, MD, Sörensson, Peder, MD, PhD, Gourine, Andrey, MD, PhD, Henareh, Loghman, MD, PhD, Persson, Jonas, MD, PhD, Saleh, Nawzad, MD, PhD, Settergren, Magnus, MD, PhD, Sundqvist, Martin, MD, Tornvall, Per, MD, PhD, Witt, Nils, MD, PhD, Böhm, Felix, MD, PhD, Pernow, John, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2016; Elsevier Limited
• Subjects: Aged; Blood clots; Cardiovascular; Cardiovascular disease; Coronary vessels; Councils; Female; Glycoproteins; Heart attacks; Heart Ventricles - diagnostic imaging; Humans; Intubation; Ischemia; Ischemic Postconditioning - methods; Ischemic Preconditioning, Myocardial - methods; Laboratories; Magnetic Resonance Imaging; Male; Medicin och hälsovetenskap; Middle Aged; Myocardial Reperfusion Injury - diagnostic imaging; Myocardial Reperfusion Injury - prevention & control; Patients; Percutaneous Coronary Intervention - methods; Severity of Illness Index; ST Elevation Myocardial Infarction - blood; ST Elevation Myocardial Infarction - diagnostic imaging; ST Elevation Myocardial Infarction - therapy; Studies; Troponin T - blood; Veins & arteries; BARI; APPROACH; Thrombolysis In Myocardial Infarction; Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease trial; Bypass Angioplasty Revascularization Investigation trial; TIMI
• ISSN: 0002-8703; 1097-6744; 1097-6744
• DOI: 10.1016/j.ahj.2016.08.004

Abstract Background Previous studies indicate that remote ischemic conditioning performed before percutaneous coronary intervention (PCI) reduces infarct size in patients with 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 ST-elevation myocardial infarction (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 min 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 four to seven. The primary outcome was myocardial salvage index (MSI). Results There was no significant difference in MSI 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.