Long‐term effect of remote ischemic conditioning on infarct size and clinical outcomes in patients with anterior ST‐elevation myocardial infarction

Abstract

Background Conflicting evidence exists concerning the cardioprotective efficacy of remote ischemic conditioning as an adjunct to primary percutaneous intervention (PCI) in ST‐elevation myocardial infarction (STEMI) and data on long‐term outcomes are scarce. We evaluated final infarct size by cardiac magnetic resonance (CMR) performed 6 months after anterior STEMI treated with remote ischemic conditioning and clinical outcomes up to 3 years after the event. Methods One hundred and fifteen patients with anterior STEMI were randomized to remote ischemic per‐postconditioning (RIperpostC) or sham procedure as adjunct to primary PCI. The primary outcome was myocardial salvage index (MSI) on CMR 6 months after the event. Secondary outcomes were absolute infarct size, left ventricular function, cardiac mortality, major adverse cardiac and cerebrovascular events (MACCE—composite of all‐cause mortality, myocardial infarction, readmission for heart failure, ischemic stroke, and target lesion revascularization) and all the individual components of MACCE. Results There was no difference in MSI or left ventricular function between the RIperpostC and the control group after 6 months. Nor did clinical outcomes at 6 months or 3 years differ between the groups. Conclusions RIperpostC as an adjunct to PCI in anterior STEMI did not result in better MSI or left ventricular function 6 months after the event. Furthermore, clinical outcomes at 6 months and 3 years were not altered.

Research status and development trends of post-myocardial infarction heart failure: a bibliometric analysis from 2012 to 2022

“…Early revascularization through PCI can effectively prevent further enlargement of the infarct area, thereby reducing the risk of heart failure and improving patient prognosis [73]. However, the clinical bene ts of remote ischemic preconditioning in reducing the risk of heart failure in STEMI patients undergoing PCI remain contentious [74,75].…”

Remote postconditioning of myocardium: mechanisms, efficacy in metabolic syndrome in experimental and clinical studies (review)

“…Значимой разницы по пику тропонина Т, а также по размеру инфаркта и индексу спасения миокарда, определяемой по МРТ с 4-го по 7-й день, между группой после ДПост и контрольной группой обнаружено не было. В последующем эти авторы проанализировали отсроченную эффективность ДПост и не выявили различий между группами по индексу спасения миокарда и частоте сердечно-сосудистых событий [60]. Важно отметить, что более половины включенных в исследование пациентов имели дислипидемию, гипергликемию или подтвержденный сахарный диабет.…”

L-Carnitine Alleviates the Myocardial Infarction and Left Ventricular Remodeling through Bax/Bcl-2 Signal Pathway

“…In post-acute MI animal models, the process of LV remodeling begins rapidly—usually within the first few hours after an infarct—and continues to progress in a long run. Several studies have demonstrated the point that infarct size is an important determinant of adverse remodeling as larger infarct size is parallel with greater LV remodeling [ 5 – 7 ]. Though mortality reduces significantly due to timely intervention and other effective therapies, prognosis remains poor in patients with large infarction and severe LV dysfunction.…”