Abstract 1611: Remote Ischemic Preconditioning Improves 6-month Outcome after Elective Percutaneous Coronary Intervention: A Single-Center Randomized Controlled Trial

Abstract

Endogenous “early” protection by remote ischemic preconditioning (rIPC) attenuates infarct size in animals but improvement in infarct size and clinical outcome in humans undergoing percutaneous coronary intervention (PCI) has not been documented. We hypothesized that rIPC would attenuate procedure-related cardiac troponin (cTnI) release during elective PCI and improve clinical outcome at 6-months. We randomized 242 patients undergoing elective PCI to either rIPC (n = 125): three 5-minute blood pressure cuff inflations to 200mmHg around the upper arm with 5-minutes of cuff deflation between, or control (n = 117): a deflated cuff throughout, before PCI. Patients taking nicorandil or glibenclamide and those with raised cTnI at baseline were excluded. Interventional cardiologists were blinded to the pretreatment protocol. Post-PCI serum cTnI level at 24-hours was recorded and major adverse cardiac and cerebral event (MACCE) rate determined at 6-months. The two groups were matched demographically. Interval between rIPC and first coronary balloon inflation was 66 ± 30 minutes. Median 24-hour cTnI was significantly lower in the rIPC group (0.06ng/mL vs. 0.16ng/mL, p=0.04). Subjects in the rIPC group experienced less chest pain (p=0.0006) and ST-segment deviation (p=0.005) during PCI than control subjects. MACCE free survival at 6-months was significantly higher in the rIPC group (Figure ), predominantly due to less acute coronary syndromes in the rIPC group (Hazard Ratio (95%CI): 0.28 (0.12– 0.82)). rIPC attenuates procedure-related cTnI release after elective PCI, and reduces 6-month MACCE rate.