Is Cardiac Remote Ischemic Preconditioning (RIPC) More Beneficial in Patients with Diabetes to Reduce Cardiac Troponin I After Elective Percutaneous Coronary Intervention (PCI)?

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Background: Intervention of choice for reperfusion is percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD), but it may have side effects; one of which is myocardial injury. Cardiac remote ischemic preconditioning (RIPC) can potentially reduce these adverse effects, especially in patients with cardiovascular risk factors. Methods: This study received ethics approval on November 29, 2017 (ethics code: HUMS.REC.1396.93; IRCT code: IRCT20180306038978N1). It was performed on 240 patients (120 cases in the RIPC group and 120 cases in the control group). The patients undergoing PCI were randomly assigned to the RIPC group (blood pressure cuff was inflated up to 200 mmHg for 30 minutes on the non-dominant arm, and then deflated for 5 minutes (reperfusion); it was repeated 2 more times (3 times in general) or the control group (an uninflated cuff around the non-dominant arm). Cardiac troponin I (cTnI) was compared between the healthy controls and diabetic patients before and after PCI. Results: No significant difference was observed with regard to positive cTnI (P = 0.136). Positive cTnI was insignificantly higher in the control group compared to the intervention group. However, the frequency of positive cTnI was significantly lower in diabetic patients in the RIPC group compared to the controls (P < 0.001). Conclusions: This study demonstrated that RIPC is beneficial in diabetic patients and reduces the release of cTnI after elective PCI in these patients.