Remote ischemic preconditioning immediately before percutaneous coronary intervention does not impact myocardial necrosis, inflammatory response, and circulating endothelial progenitor cell counts: A single center randomized sham controlled trial

Prasad, Abhiram; Gössl, Mario; Hoyt, John R.; Lennon, Ryan J.; Polk, Lynn; Simari, Robert; Holmes, David R.; Rihal, Charanjit S.; Lerman, Amir

doi:10.1002/ccd.24443

Cited by 68 publications

(50 citation statements)

References 19 publications

(22 reference statements)

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“…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. 115,116,126 The studies in patients either undergoing exclusively CABG or CABG with additional valve surgery were heterogeneous in their result.…”

Section: Remote Ischemic Conditioningmentioning

confidence: 66%

Time to Give Up on Cardioprotection?

Heusch

Rassaf

2016

Circulation Research

170

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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

170

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“…A meta-analysis of randomized single-center trials reported a reduction of long-term major adverse cardiovascular and cerebral events and all-cause mortality [5]. While RIC is an easy, feasible and safe procedure, not all studies confirm that it offers cardioprotection [6,7,8,9,10,11,12,13], and all of the positive studies reported have been performed on selected patient cohorts under well-controlled conditions. Therefore, the use of RIC in daily clinical practice is still uncertain [14] and is the subject of ongoing large-scale multicenter trials [15,16].…”

Section: Introductionmentioning

confidence: 99%

Confounders of Cardioprotection by Remote Ischemic Preconditioning in Patients Undergoing Coronary Artery Bypass Grafting

et al. 2015

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Objectives: Remote ischemic conditioning (RIC) by repetitive blood pressure cuff inflation/deflation around a limb provides cardioprotection in patients undergoing coronary artery bypass grafting (CABG). Cardioprotection is confounded by risk factors, comorbidities and comedications. We aimed to identify confounders that possibly attenuate the protection provided by RIC. Methods: In a retrospective analysis of our single-center, randomized, double-blind trial of patients undergoing elective CABG with/without RIC prior to ischemic cardioplegic arrest, we analyzed demographics, medications and intraoperative variables. The primary end point was myocardial injury, as reflected by the area under the curve for serum troponin I (TnI) from baseline to 72 h after surgery. Results: In models with 2 independent variables and in the multivariate analysis, age and aortic cross-clamp time impacted on TnI release. Subgroup analyses confirmed RIC-induced protection in all age tertiles. There was no protection with an aortic cross-clamp time ≤56 min (RIC/control = 1.026 not significant), but there was protection with 57-75 min (RIC/control = 0.757; p = 0.0348) and ≥76 min (RIC/control = 0.735; p = 0.0277). Gender, β-blockers, statins, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) and intraoperative nitroglycerine did not impact on TnI release. Conclusion: Age, gender, β-blockers, statins, ACE inhibitors, ARBs and intraoperative nitroglycerine have no significant impact on RIC-induced cardioprotection during CABG. However, greater myocardial ischemia/reperfusion injury at longer cross-clamp time facilitates the detection of protection by RIC.

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“…First, the CRISP study did not include patients with unstable angina or raised baseline troponin levels, in addition to the remote conditioning protocol used (remote preconditioning versus remote postconditioning). Most evidence concerns preconditioning, though no optimal time has yet been established between the preconditioning and the angioplasty and not all studies on preconditioning have found positive results for this profile of patients 26. Accordingly, one could think that the stimulus applied in our study was too late.…”

Section: Discussionmentioning

confidence: 86%

Remote ischaemic postconditioning: does it protect against ischaemic damage in percutaneous coronary revascularisation? Randomised placebo-controlled clinical trial

Carrasco-Chinchilla

Muñoz-García

Domínguez-Franco

et al. 2013

Heart

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Remote ischemic preconditioning immediately before percutaneous coronary intervention does not impact myocardial necrosis, inflammatory response, and circulating endothelial progenitor cell counts: A single center randomized sham controlled trial

Abstract: Our study indicates that remote IP immediately before PCI does not induce cardioprotection in low to moderate risk patients.

Cited by 68 publications

References 19 publications

Time to Give Up on Cardioprotection?

Time to Give Up on Cardioprotection?

Confounders of Cardioprotection by Remote Ischemic Preconditioning in Patients Undergoing Coronary Artery Bypass Grafting

Remote ischaemic postconditioning: does it protect against ischaemic damage in percutaneous coronary revascularisation? Randomised placebo-controlled clinical trial

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