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

Abstract

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.

Keywords

• Remote ischemic preconditioning,percutaneous coronary intervention

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

Abstract

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.

Keywords

• İskemik ön koşullanma,perkütan koroner girişim

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