Remote ischemic post-conditioning of the lower limb during primary percutaneous coronary intervention safely reduces enzymatic infarct size in anterior myocardial infarction: a randomized controlled trial

• Published in: JACC. Cardiovascular interventions Vol. 6; no. 10; p. 1055
• Main Authors: Crimi, Gabriele, Pica, Silvia, Raineri, Claudia, Bramucci, Ezio, De Ferrari, Gaetano M, Klersy, Catherine, Ferlini, Marco, Marinoni, Barbara, Repetto, Alessandra, Romeo, Maurizio, Rosti, Vittorio, Massa, Margherita, Raisaro, Arturo, Leonardi, Sergio, Rubartelli, Paolo, Oltrona Visconti, Luigi, Ferrario, Maurizio
• Format: Journal Article
• Language: English
• Published: United States 01.10.2013
• Subjects: Aged; Anterior Wall Myocardial Infarction - blood; Anterior Wall Myocardial Infarction - diagnosis; Anterior Wall Myocardial Infarction - physiopathology; Anterior Wall Myocardial Infarction - therapy; Area Under Curve; Biomarkers - blood; Creatine Kinase, MB Form - blood; Female; Humans; Ischemic Postconditioning - methods; Italy; Lower Extremity - blood supply; Magnetic Resonance Imaging; Male; Middle Aged; Myocardial Reperfusion Injury - blood; Myocardial Reperfusion Injury - diagnosis; Myocardial Reperfusion Injury - physiopathology; Myocardial Reperfusion Injury - prevention & control; Myocardium - enzymology; Myocardium - pathology; Percutaneous Coronary Intervention - adverse effects; Predictive Value of Tests; ROC Curve; Time Factors; Treatment Outcome; Italy; DE; cardiac magnetic resonance imaging; inhibitors of glycoprotein IIb/IIIa; myocardial infarction; primary percutaneous coronary intervention; CK-MB; LV; Thrombolysis In Myocardial Infarction; interquartile range; RIPC; STR; myocardial conditioning; MBG; STEMI; contrast enhanced cardiac magnetic resonance; T-weighted; left ventricle/ventricular; creatine kinase-myocardial band; myocardial blush grading; delayed enhancement; CI; remote ischemic post-conditioning; ce-CMR; primary angioplasty; IQR; myocardial reperfusion injury; LAD; pPCI; anti-GP IIb/IIIa; left anterior descending; TIMI; ST-segment resolution; T2W; confidence interval; ST-segment elevation myocardial infarction
• ISSN: 1876-7605; 1876-7605
• DOI: 10.1016/j.jcin.2013.05.011

This study sought to evaluate whether remote ischemic post-conditioning (RIPC) could reduce enzymatic infarct size in patients with anterior ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (pPCI). Myocardial reperfusion injury may attenuate the benefit of pPCI. In animal models, RIPC mitigates myocardial reperfusion injury. One hundred patients with anterior ST-segment elevation myocardial infarction and occluded left anterior descending artery were randomized to pPCI + RIPC (n = 50) or conventional pPCI (n = 50). RIPC consisted of 3 cycles of 5 min/5 min ischemia/reperfusion by cuff inflation/deflation of the lower limb. The primary endpoint was infarct size assessed by the area under the curve of creatinine kinase-myocardial band release (CK-MB). Secondary endpoints included the following: infarct size assessed by cardiac magnetic resonance delayed enhancement volume; T2-weighted edema volume; ST-segment resolution >50%; TIMI (Thrombolysis In Myocardial Infarction) frame count; and myocardial blush grading. Four patients (2 RIPC, 2 controls) were excluded due to missing samples of CK-MB. A total of 96 patients were analyzed; median area under the curve CK-MB was 8,814 (interquartile range [IQR]: 5,567 to 11,325) arbitrary units in the RIPC group and 10,065 (IQR: 7,465 to 14,004) arbitrary units in control subjects (relative reduction: 20%, 95% confidence interval: 0.2% to 28.7%; p = 0.043). Seventy-seven patients underwent a cardiac magnetic resonance scan 3 to 5 days after randomization, and 66 patients repeated a second scan after 4 months. T2-weighted edema volume was 37 ± 16 cc in RIPC patients and 47 ± 22 cc in control subjects (p = 0.049). ST-segment resolution >50% was 66% in RIPC and 37% in control subjects (p = 0.015). We observed no significant differences in TIMI frame count, myocardial blush grading, and delayed enhancement volume. In patients with anterior ST-segment elevation myocardial infarction, RIPC at the time of pPCI reduced enzymatic infarct size and was also associated with an improvement of T2-weighted edema volume and ST-segment resolution >50%. (Remote Postconditioning in Patients With Acute Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention [PCI] [RemPostCon]; NCT00865722).