Remote ischemic preconditioning is feasible in ad hoc percutaneous coronary interventions

Abstract

Purpose: Percutaneous coronary intervention (PCI)-induced troponin cTnI release is associated with a worst prognosis. Recently, 3 cycles of 5-minute ischemia followed by 5-minute reperfusion of the upper extremities were shown to reduce troponin release in elective PCI. However, this ischemic preconditioning (IPC) protocol requires 30 minutes and is of limited use in the context of ad hoc PCI. Since experimental evidence suggests that IPC is a graded than an all-or-nothing phenomenon, and even a short, single IPC cycle may have protective effects in the myocardium, we hypothesized that patients undergoing ad hoc PCI would have reduced peri-procedural troponin release if subjected to a single, remote IPC cycle, between diagnostic catheterization and coronary intervention. Methods: Subjects were randomized to receive remote IPC (induced by one single 5-minute inflation of a blood pressure cuff to 200 mm Hg around the upper arm, followed by 1 minute of reperfusion) or control (an uninflated cuff around the arm) in the catheter laboratory. The primary outcome was the difference between post-procedural cTnI (at 24 hours after PCI) and pre-procedural cTnI. Results: Ninety-three patients were included in the study (46 control group, 47 remote IPC group). Peri-procedural troponin release was significantly higher in the control group compared to the remote IPC group (0.49±0.42 vs. 0.10±0.19, p<0.001). No significant difference in ECG ST-segment deviation or ischemic discomfort was observed. Conclusion: One cycle of remote IPC attenuates procedure-related cTnI release, thus IPC may be feasible without introducing any delays in the catheter laboratory.