Original Contribution

Basic Research in Cardiology

, 109:400

First online:

The RIPOST-MI study, assessing remote ischemic perconditioning alone or in combination with local ischemic postconditioning in ST-segment elevation myocardial infarction

  • Fabrice PrunierAffiliated withService de Cardiologie, EA 3860, Laboratoire Cardioprotection, Remodelage et Thrombose, Université Angers, CHU Angers Email author 
  • , Denis AngoulvantAffiliated withService de Cardiologie, EA 4245, Cellules Dendritiques Immunomodulation et Greffes, Université François Rabelais de Tours, CHRU de Tours
  • , Christophe Saint EtienneAffiliated withService de Cardiologie, EA 4245, Cellules Dendritiques Immunomodulation et Greffes, Université François Rabelais de Tours, CHRU de Tours
  • , Emmanuelle VermesAffiliated withService de Cardiologie, EA 4245, Cellules Dendritiques Immunomodulation et Greffes, Université François Rabelais de Tours, CHRU de Tours
  • , Martine GilardAffiliated withService de Cardiologie, Université Brest, CHU Brest
  • , Christophe PiotAffiliated withService de Cardiologie, Université 1 Montpellier, CHU Montpellier
  • , François RoubilleAffiliated withService de Cardiologie, Université 1 Montpellier, CHU Montpellier
  • , Meyer ElbazAffiliated withService de Cardiologie, Université Toulouse, CHU Toulouse
  • , Michel OvizeAffiliated withService d’Explorations Fonctionnelles Cardiovasculaires, Inserm U1060-CarMeN, CIC de Lyon, Université Claude Bernard Lyon1, Hôpital Louis Pradel
    • , Loïc BièreAffiliated withService de Cardiologie, EA 3860, Laboratoire Cardioprotection, Remodelage et Thrombose, Université Angers, CHU Angers
    • , Julien JeanneteauAffiliated withService de Cardiologie, EA 3860, Laboratoire Cardioprotection, Remodelage et Thrombose, Université Angers, CHU Angers
    • , Stéphane DelépineAffiliated withService de Cardiologie, EA 3860, Laboratoire Cardioprotection, Remodelage et Thrombose, Université Angers, CHU Angers
    • , Thomas BenardAffiliated withService de Cardiologie, EA 3860, Laboratoire Cardioprotection, Remodelage et Thrombose, Université Angers, CHU Angers
    • , Wissam Abi-KhalilAffiliated withService de Cardiologie, EA 3860, Laboratoire Cardioprotection, Remodelage et Thrombose, Université Angers, CHU Angers
    • , Alain FurberAffiliated withService de Cardiologie, EA 3860, Laboratoire Cardioprotection, Remodelage et Thrombose, Université Angers, CHU Angers

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Abstract

Local ischemic postconditioning (IPost) and remote ischemic perconditioning (RIPer) are promising cardioprotective therapies in ST-elevation myocardial infarction (STEMI). We aimed: (1) to investigate whether RIPer initiated at the catheterization laboratory would reduce infarct size, as measured using serum creatine kinase-MB isoenzyme (CK-MB) release as a surrogate marker; (2) to assess if the combination of RIPer and IPost would provide an additional reduction. Patients (n = 151) were randomly allocated to one of the following groups: (1) control group, percutaneous transluminal coronary angioplasty (PTCA) alone; (2) RIPer group, PTCA combined with RIPer, consisting of three cycles of 5-min inflation and 5-min deflation of an upper-arm blood-pressure cuff initiated before reperfusion; (3) RIPer+IPost group, PTCA combined with RIPer and IPost, consisting of four cycles of 1-min inflation and 1-min deflation of the angioplasty balloon. The CK-MB area under the curve (AUC) over 72 h was reduced in RIPer, and RIPer+IPost groups, by 31 and 29 %, respectively, compared to the Control group; however, CK-MB AUC differences between the three groups were not statistically significant (p = 0.06). Peak CK-MB, CK-MB AUC to area at risk (AAR) ratio, and peak CK-MB level to AAR ratio were all significantly reduced in the RIPer and RIPer+IPost groups, compared to the Control group. On the contrary, none of these parameters was significantly different between RIPer+IPost and RIPer groups. To conclude, starting RIPer therapy immediately prior to revascularization was shown to reduce infarct size in STEMI patients, yet combining this therapy with an IPost strategy did not lead to further decrease in infarct size.

Keywords

Cardioprotection Remote conditioning Reperfusion injury