Long-term Results of One Cycle of Remote Ischemic Preconditioning Applied Before Elective Percutaneous Coronary Intervention

Yıl 2018, Cilt: 21 Sayı: 2, 143 - 148, 19.08.2018

Mustafa Yılmaztepe Gökay Taylan Fatih Mehmet Uçar Uğur Özkan Meryem Aktoz Hanefi Yekta Gürlertop

Öz

Introduction:
Myocardial
injury after percutaneous coronary intervention (PCI) is seen frequently.
Ischemia/reperfusion injury, side branch occlusion and distal embolization of
atherothrombotic debris are the main causes of myocardial injury. Remote
ischemic preconditioning (RIPC) is a promising technique for protection from
ischemia/reperfusion injury, but sufficient data of long-term clinical outcomes
is not available. In this study we planned to investigate the effect of one
cycle of RIPC on major cardiovascular events one year after elective PCI.

Patients
and Methods: 102 patients, undergoing elective PCI, with normal
baseline cTroponin-I (cTn-I) values, were randomized equally into two groups.
Five minutes of ischemic preconditioning was applied before the intervention to
the preconditioning group, by inflating blood pressure cuff up-to 200 mmHg on
non-dominant arm. After 1 year, the clinical outcomes of these patients
(angina, heart failure, death, myocardial infarction, repeat revascularization)
were questioned.

Results: From a total of 102
patients, 90 could be reached after an year. The mean duration of follow-up was
432 vs. 423.5 days (p= 0.793). Post-PCI 16^th hour cTn-I was insignificantly
lower in the preconditioning arm (0.079 μg/L vs. 0.069 μg/L, p= 0.074). The
incidence of cTn-I elevation 5 fold above the URL (> 0.115 μg/L) was lower
in the preconditioning group; however, it was also insignificant (24.4% vs.
13.3%, p= 0.301). Death, MI or repeat revascularization rates did not differ
between the groups.

Anahtar Kelimeler

Remote ischemic preconditioning, percutaneous coronary intervention

Elektif Perkütan Koroner Girişim Öncesi Uygulanan Uzaktan İskemik Ön Koşullanmanın Uzun Dönem Sonuçları

Öz

Giriş: Perkütan koroner girişim sonrası miyokart hasarı sıklıkla
görülmektedir. Miyokart hasarı iskemi/reperfüzyon hasarına, yan dal tıkanmasına
ve aterotrombotik debrisi distal embolizasyonuna bağlı gelişmektedir. Uzaktan
iskemik ön koşullanma iskemi reperfüzyon hasarından korunmada ümit verici
teknikledendir ancak uzun dönem sonuçları ile ilgili yeterli veri henüz
bulunmamaktadır. Biz bu çalışmada 
perkütan koroner girişim öncesi uygulanan tek sefer uzaktan ön
koşullanmanın bir yıl sonunda majör kardiyovasküler olaylar üzerine etkisini
araştırmayı planladık.

Hastalar ve Yöntem: Elektif perkütan koroner girişim
planlanan 102 hasta çalışmaya alındı ve hastalar iki gruba randomize edildi. Ön
koşullanma grubundaki hastalara girişimden önce, kan basıncı manşonu 5 dakika
boyunca 200 mmHg’da şişirilerek ön koşullanma uygulandı. İşlem öncesi ve
sonrası cTroponin-I değerlerine bakıldı. Birinci yıl sonunda hastaların klinik
durumları sorgulandı (angina, kalp yetersizliği, ölüm, miyokart infarktüsü,
tekrar revaskülarizasyon).

Bulgular: Yüz iki hastanın 90’ına ulaşılabildi. Ortalama takip
süresi 432 vs. 423.5 gün (p= 0.793). Ön koşullanma grubunda koroner girişim
sonrası 16. saat cTroponin-I değeri kontrol grubuna göre daha düşük bulundu
ancak istatistiksel anlamlılık saptanmadı (0.079 μg/L vs. 0.069 μg/L, p=
0.074). cTroponin-I beş kat arttığı hasta oranı da ön koşullanma grubunda daha
azdı ancak bu fark da istatistiksel olarak anlamlı saptanmadı (24.4% vs. 13.3%,
p= 0.301). Ölüm, miyokart infarktüsü ve tekrar revaskülarizasyon açısından
gruplar arasında fark saptanmadı.

Sonuç: Tek sefer uzaktan iskemik
ön koşullanmanın elektif perkütan koroner girişim sonrası majör kardiyovasküler
olaylar üzerine etkisi saptanmamıştır.

Anahtar Kelimeler

İskemik ön koşullanma, perkütan koroner girişim

Kaynakça

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