Effect of Remote Ischemic Preconditioning in the Elderly Patients With Coronary Artery Disease With Diabetes Mellitus Undergoing Elective Drug-Eluting Stent Implantation

Xu, Xiaohua; Zhou, Yujie; Luo, Shengjie; Zhang, Weijun; Zhao, Yan; Ming, Yu; Ma, Qin; Gao, Fei; Shen, Hua; Zhang, Jianwei

doi:10.1177/0003319713507332

Cited by 50 publications

(45 citation statements)

References 41 publications

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“…A retrospective analysis of the CONDI trial (Effect of Remote Ischemic Conditioning on Clinical Outcome in (Table 3). A similar pattern with infarct size reduction in the majority but not all studies (with 2 small extreme outlier studies reporting even increased infarct size by remote ischemic preconditioning 114,115 ) emerged for elective PCI when either remote ischemic pre- [116][117][118][119][120][121][122][123] or postconditioning 124,125 was used for cardioprotection. In some of these studies, clinical outcome was reported as a secondary outcome, and it was either not different 106,119,124 or improved.…”

Section: Remote Ischemic Conditioningmentioning

confidence: 66%

Time to Give Up on Cardioprotection?

Heusch

Rassaf

2016

Circulation Research

174

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Abstract:The mortality from acute myocardial infarction (AMI) remains significant, and the prevalence of postmyocardial infarction heart failure is increasing. Therefore, cardioprotection beyond timely reperfusion is needed. Conditioning procedures are the most powerful cardioprotective interventions in animal experiments. However, ischemic preconditioning cannot be used to reduce infarct size in patients with AMI because its occurrence is not predictable; several studies in patients undergoing surgical coronary revascularization report reduced release of creatine kinase and troponin. Ischemic postconditioning reduces infarct size in most, but not all, studies in patients undergoing interventional reperfusion of AMI, but may require direct stenting and exclusion of patients with >6 hours of symptom onset to protect. Remote ischemic conditioning reduces infarct size in patients undergoing interventional reperfusion of AMI, elective percutaneous or surgical coronary revascularization, and other cardiovascular surgery in many, but not in all, studies. Adequate dose-finding phase II studies do not exist. There are only 2 phase III trials, both on remote ischemic conditioning in patients undergoing cardiovascular surgery, both with neutral results in terms of infarct size and clinical outcome, but also both with major problems in trial design. We discuss the difficulties in translation of cardioprotection from animal experiments and proof-ofconcept trials to clinical practice. Given that most studies on ischemic postconditioning and all studies on remote ischemic preconditioning in patients with AMI reported reduced infarct size, it would be premature to give up on cardioprotection. (Circ Res. 2016;119:676-695.

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Section: Remote Ischemic Conditioningmentioning

confidence: 66%

Time to Give Up on Cardioprotection?

Heusch

Rassaf

2016

Circulation Research

174

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“…However, it is difficult to distinguish the effect of diabetes from that of age on the remote ischemic preconditioning protocol. Furthermore, the authors of this study did not demonstrate that their remote ischemic preconditioning protocol was effective in a younger nondiabetic population (Xu et al, 2014). In an intriguing clinical study by Jensen et al (2012) it was reported that diabetic patients with a peripheral neuropathy failed to produce a cardioprotective humoral factor in response to a standard remote ischemic preconditioning protocol (4 Â 5-minute upper arm cuff inflation/deflation) compared with nondiabetic and diabetic patients who did not have a peripheral neuropathy.…”

Section: Diabetesmentioning

confidence: 72%

“…Although many of these clinical studies included diabetic patients they did not specifically address the question of whether the diabetic heart was amenable to remote ischemic conditioning. Xu et al (2014) found that a standard remote ischemic conditioning stimulus (3 Â 5-minute upper arm cuff inflations/deflation) did not reduce the magnitude or incidence of periprocedural myocardial injury during elective PCI in older patients (mean age 69 years) with diabetes. However, it is difficult to distinguish the effect of diabetes from that of age on the remote ischemic preconditioning protocol.…”

Section: Diabetesmentioning

confidence: 88%

Interaction of Risk Factors, Comorbidities, and Comedications with Ischemia/Reperfusion Injury and Cardioprotection by Preconditioning, Postconditioning, and Remote Conditioning

Ferdinándy¹,

Hausenloy²,

Heusch³

et al. 2014

Pharmacol Rev

513

501

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“…With the exception that the percentage of patients with diabetes was lower in the study of Zografos et al , the sample size and study population were similar in both studies (21% vs. 31%). The presence of DM could attenuate the protective effects of RIPC [30]. The diabetic group in our study constituted about one third of the study population, without a significant difference between groups.…”

Section: Discussionmentioning

confidence: 94%

“…Although RIPC has promising effects, there are limited data about its effects in planned PCI. Different protocols, to test the possible protective effects of RIPC, were chosen in the previous studies [7, 12, 25–30]. The study by Iliodromitis et al .…”

Section: Discussionmentioning

confidence: 99%

The impact of a single episode of remote ischemic preconditioning on myocardial injury after elective percutaneous coronary intervention

Yılmaztepe

Taylan

Aktöz

et al. 2017

pwki

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IntroductionMyocardial injury after percutaneous coronary intervention (PCI) occurs in approximately 30% of procedures, and is related to worse prognosis. Effects of remote ischemic preconditioning (RIPC) on reperfusion injury have been investigated before, yielding conflicting results.AimTo assess the impact of a single episode of RIPC on myocardial injury after elective PCI.Material and methodsOne hundred and four patients undergoing elective PCI, with normal baseline cardiac troponin-I (cTn-I) values, were randomized to two groups. Two patients were excluded due to data loss, and 102 patients were analyzed. Five minutes of ischemic preconditioning was delivered just before the intervention to the preconditioning group, by inflating the blood pressure cuff up to 200 mm Hg on the non-dominant arm. Postprocedural 16th hour cTn-I, ΔcTn-I (difference between the 16th h and baseline cTn-I values) and the prevalence of type 4a myocardial infarction were compared between the two groups.ResultsMedian cTn-I values after the procedure were compared. 16th hour cTn-I was insignificantly lower in the preconditioning arm (0.026 μg/l vs. 0.045 μg/l, p = 0.186). The incidence of cTn-I elevation 5-fold above the upper reference limit (URL) (> 0.115 μg/l) was lower in the preconditioning group, but it was also not significant (21.6% vs. 11.8%, p = 0.184).ConclusionsA single episode of RIPC before elective PCI demonstrated less troponin elevation but failed to show a significant effect.

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Effect of Remote Ischemic Preconditioning in the Elderly Patients With Coronary Artery Disease With Diabetes Mellitus Undergoing Elective Drug-Eluting Stent Implantation

Cited by 50 publications

References 41 publications

Time to Give Up on Cardioprotection?

Time to Give Up on Cardioprotection?

Interaction of Risk Factors, Comorbidities, and Comedications with Ischemia/Reperfusion Injury and Cardioprotection by Preconditioning, Postconditioning, and Remote Conditioning

The impact of a single episode of remote ischemic preconditioning on myocardial injury after elective percutaneous coronary intervention

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