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Cell Biochemistry and Biophysics

, Volume 70, Issue 1, pp 437–442 | Cite as

Late Remote Ischemic Preconditioning Provides Benefit to Patients Undergoing Elective Percutaneous Coronary Intervention

  • Zhi Liu
  • Yan-Ling Wang
  • Dong Xu
  • Qi Hua
  • Yan-Yan Chu
  • Xun-Ming Ji
Original Paper

Abstract

To assess whether late remote ischemic preconditioning (L-RIPC) is effective in myocardial protection in patients with ischemic heart disease undergoing elective percutaneous coronary intervention (PCI). L-RIPC is exerted by newly synthesized cardioprotective proteins. The cardioprotective effects of L-RIPC are more durable. 200 consecutive patients undergoing elective PCI were randomized to receive L-RIPC (induced by three 5-minute inflations of a blood pressure cuff to 200 mmHg around the upper arm, followed by 5-min intervals of reperfusion) or control (an uninflated cuff around the arm) at 18 h before PCI. Creatine phosphokinase (CK), its cardiac isoenzyme (CK-MB), troponin I (TNI), and high-sensitivity C-reactive protein (hs-CRP) levels were measured at 24 h after PCI. Adverse events’ rates at 6 months were assessed. Compared with the control group, patients in L-RIPC group were observed with significantly lower incidences in Chest pain score >1 and ECG ST deviation >1 mm (P < 0.05). The median TNI, CK, and CK-MB concentrations at 24 h were lower in the L-RIPC group (0.009 vs. 0.036 ng/mL, 123 vs. 186 IU/L, 15 vs. 27 IU/L; P < 0.05). There was no statistical difference in hs-CRP between two groups. At 6 months, the adverse events’ rate was lower in the L-RIPC group (P = 0.036). L-RIPC is effective in myocardial protection in patients undergoing elective PCI and reduces adverse events’ rate at 6 months.

Keywords

Late remote ischemic preconditioning Ischemic heart disease Elective percutaneous coronary intervention Troponin I 

Notes

Conflict of interest

None of authors have a conflict of interest.

Disclosure

The contents are solely the responsibility of the authors and do not represent the official view of any organization.

References

  1. 1.
    Szijártó, A., Czigány, Z., Turóczi, Z., et al. (2012). Remote ischemic perconditioning-a simple, low-risk method to decrease ischemic reperfusion injury: Models, protocols and mechanistic background. Journal of Surgical Research, 178, 797–806.PubMedCrossRefGoogle Scholar
  2. 2.
    Ghaemian, A., Nouraei, S. M., Abdollahian, F., et al. (2012). Remote ischemic preconditioning in percutaneous coronary revascularization: A double-blind randomized controlled clinical trial. Asian Cardiovascular and Thoracic Annals, 20, 548–554.PubMedCrossRefGoogle Scholar
  3. 3.
    Bøtker, H. E., Kharbanda, R., Schmidt, M. R., et al. (2010). Remote ischaemic conditioning before hospital admission, as a complement to angioplasty, and effect on myocardial salvage in patients with acute myocardial infarction: A randomised trial. Lancet, 375, 727–734.PubMedCrossRefGoogle Scholar
  4. 4.
    Nageh, T., Sherwood, R. A., Harris, B. M., et al. (2005). Prognostic role of cardiac troponin I after percutaneous coronary intervention in stable coronary disease. Heart, 91, 1181–1185.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Hausenloy, D. J., Mwamure, P. K., Venugopal, V., et al. (2007). Effect of remote ischaemic preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery: A randomised controlled trial. Lancet, 370, 575–579.PubMedCrossRefGoogle Scholar
  6. 6.
    Schmidt, M. R., Sloth, A. D., Johnsen, J., et al. (2012). Remote ischemic conditioning: The cardiologist’s perspective. Journal of Cardiovascular Medicine (Hagerstown), 13, 667–674.CrossRefGoogle Scholar
  7. 7.
    Qiao, S., Xie, H., Wang, C., et al. (2012). Delayed anesthetic preconditioning protects against myocardial infarction via activation of nuclear factor-κB and upregulation of autophagy. Journal of Anesthesia, 27, 251–260.PubMedCrossRefGoogle Scholar
  8. 8.
    Kocsis, G. F., Sárközy, M., Bencsik, P., et al. (2012). Preconditioning protects the heart in a prolonged uremic condition. American Journal of Physiology Heart and Circulatory Physiology, 303, H1229–H1236.PubMedCrossRefGoogle Scholar
  9. 9.
    Ahmed, L. A., Salem, H. A., Mawsouf, M. N., et al. (2012). Cardioprotective effects of ozone oxidative preconditioning in an in vivo model of ischemia/reperfusion injury in rats. Scandinavian Journal of Clinical and Laboratory Investigation, 72, 345–354.PubMedCrossRefGoogle Scholar
  10. 10.
    Minamino, T. (2012). Cardioprotection from ischemia/reperfusion injury: basic and translational research. Circulation Journal, 76, 1074–1082.PubMedCrossRefGoogle Scholar
  11. 11.
    Millar, P. J., & McGowan, C. L. (2012). Serial remote ischemic preconditioning and rhythmic isometric exercise training: A hypothesis. Medical Hypotheses, 78, 822–823.PubMedCrossRefGoogle Scholar
  12. 12.
    Loukogeorgakis, S. P., Williams, R., Panagiotidou, A. T., et al. (2007). Transient limb ischemia induces remote preconditioning and remote postconditioning in humans by a K(ATP)-channel dependent mechanism. Circulation, 116, 1386–1395.PubMedCrossRefGoogle Scholar
  13. 13.
    Duan, X., Ji, B., Wang, X., et al. (2012). Expression of microRNA-1 and microRNA-21 in different protocols of ischemic conditioning in an isolated rat heart model. Cardiology, 122, 36–43.PubMedCrossRefGoogle Scholar
  14. 14.
    Dow, J., Bhandari, A., Simkhovich, B. Z., et al. (2012). The effect of acute versus delayed remote ischemic preconditioning on reperfusion induced ventricular arrhythmias. Journal of Cardiovascular Electrophysiology, 23, 1374–1383.PubMedCrossRefGoogle Scholar
  15. 15.
    Meybohm, P., Zacharowski, K., Cremer, J., RIP Heart-Study Investigator Group, et al. (2012). Remote ischaemic preconditioning for heart surgery. The study design for a multi-center randomized double-blinded controlled clinical trial—The RIPHeart-Study. European Heart Journal, 33, 1423–1426.PubMedGoogle Scholar
  16. 16.
    Pilcher, J. M., Young, P., Weatherall, M., et al. (2012). A systematic review and meta-analysis of the cardioprotective effects of remote ischaemic preconditioning in open cardiac surgery. Journal of the Royal Society of Medicine, 105, 436–445.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Wagner, R., Piler, P., Bedanova, H., et al. (2010). Myocardial injury is decreased by late remote ischaemic preconditioning and aggravated by tramadol in patients undergoing cardiac surgery: A randomised controlled trial. Interactive Cardio Vascular and Thoracic Surgery, 11, 758–762.CrossRefGoogle Scholar
  18. 18.
    Hoole, S. P., Heck, P. M., Sharples, L., et al. (2009). Cardiac remote ischemic preconditioning in coronary stenting (CRISP stent) study: A prospective, randomized control trial. Circulation, 119, 820–827.PubMedCrossRefGoogle Scholar
  19. 19.
    Porto, I., Selvanayagam, J. B., Van Gaal, W. J., et al. (2006). Plaque volume and occurrence and location of periprocedural myocardial necrosis after percutaneous coronary intervention: insights from delayed-enhancement magnetic resonanceimaging, thrombolysis in myocardial infarction myocardial perfusion grade analysis, and intravascular ultrasound. Circulation, 114, 662–669.PubMedCrossRefGoogle Scholar
  20. 20.
    Ramirez-Moreno, A., Cardenal, R., Pera, C., et al. (2004). Predictors and prognostic value of myocardial injury following stent implantation. International Journal of Cardiology, 97, 193–198.PubMedCrossRefGoogle Scholar
  21. 21.
    Brevoord, D., Kranke, P., Kuijpers, M., et al. (2012). Remote ischemic conditioning to protect against ischemia-reperfusion injury: A systematic review and meta-analysis. PLoS ONE, 7, e42179.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Dm, R., Ve, H., Ge, T., et al. (2012). Remote ischemic preconditioning reduces thrombus formation in the rat. The Journal of Thrombosis and Haemostasis, 10, 1538–7836.Google Scholar
  23. 23.
    Hepponstall, M., Ignjatovic, V., Binos, S., et al. (2012). Remote ischemic preconditioning (RIPC) Modifies plasma proteome in humans. PLoS ONE, 7, e48284.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Zhi Liu
    • 1
  • Yan-Ling Wang
    • 1
  • Dong Xu
    • 1
  • Qi Hua
    • 1
  • Yan-Yan Chu
    • 1
  • Xun-Ming Ji
    • 2
  1. 1.Department of Cardiology, Xuanwu HospitalCapital Medical UniversityBeijingChina
  2. 2.Department of Intervention, Xuanwu HospitalCapital Medical UniversityBeijingChina

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