Renoprotective Effect of Remote Ischemic Post-Conditioning by Intermittent Balloon Inflations in Patients Undergoing Percutaneous Coronary Intervention

Deftereos, Spyridon; Γιαννόπουλος, Γεώργιος; Tzalamouras, Vasileios; Raisakis, Konstantinos; Kossyvakis, Charalambos; Kaoukis, Andreas; Panagopoulou, Vasiliki; Karageorgiou, Sofia; Avramides, Dimitrios; Toutouzas, Konstantinos; Hahalis, George; Pyrgakis, Vlassios; Manolis, Antonis S.; Alexopoulos, Dimitrios; Stefanadis, Christodoulos; Cleman, Michael

doi:10.1016/j.jacc.2013.02.023

Cited by 86 publications

(78 citation statements)

References 22 publications

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“…RIPost has recently been reported to reduce PCI-related AKI in a randomized study of 225 patients. 43 In that study, the mode of RIPost was cyclic inflations of the stent balloon, after stent deployment, to nominal pressures for 30 seconds. The investigators demonstrated a significant reduction in PCI-related AKI, using the same definition as used in the current study.…”

Section: Discussionmentioning

confidence: 99%

Remote Ischemic Postconditioning During Percutaneous Coronary Interventions

Lavi

D'Alfonso

Diamantouros

et al. 2014

Circ: Cardiovascular Interventions

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Background-Remote ischemic preconditioning may result in reduction in infarct size during percutaneous coronary intervention (PCI). It is unclear whether remote ischemic postconditioning (RIPost) will reduce the incidence of myocardial injury after PCI, and whether ischemic conditioning of a larger remote organ (thigh versus arm) would provide further myocardial protection. Methods and Results-We randomized 360 patients presenting with stable or unstable angina (28% of patients) and negative Troponin T at baseline to 3 groups: 2 groups received RIPost (induced by ischemia to upper or lower limb), and a third was the control group. RIPost was applied during PCI immediately after stent deployment, by three 5-minute cycles of blood pressure cuff inflation to >200 mm Hg in the arm or thigh (20 mm Hg in the control) with 5-minute breaks between each cycle. The primary end-point was the proportion of patients with Troponin T levels >3×ULN postprocedure (at 6 or 18-24 hours), where ULN stands for upper limit of normal. A total of 120 patients were randomized to each group. There were no differences in baseline characteristics between the 3 groups. The primary outcome occurred in 30%, 35%, and 35% of the arm, thigh, and control groups, respectively (P=0.64). There were no differences in creatine kinase or high sensitivity C-reactive protein levels after PCI or in the incidence of acute kidney injury between the groups. Conclusions-RIPost during PCI did not reduce the incidence of periprocedural myocardial injury. Similar effect was obtained when remote ischemia was induced to the upper or lower limb. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00970827.(Circ Cardiovasc Interv. 2014;7:225-232.)

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Section: Discussionmentioning

confidence: 99%

Remote Ischemic Postconditioning During Percutaneous Coronary Interventions

Lavi

D'Alfonso

Diamantouros

et al. 2014

Circ: Cardiovascular Interventions

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“…Despite these limitations, we still perceived a durable clinical benefit of RIPC-treated patients undergoing elective PCI. We think this was attributable to RIPC limiting PCI-induced myonecrosis, but acknowledge that protection of other organs and specifically renoprotection 24 may have also contributed. However, our findings need to be confirmed in a large, multicenter, randomized, control trial adequately powered for clinical events.…”

Section: Study Limitationsmentioning

confidence: 98%

Remote Ischemic Preconditioning Improves Outcome at 6 Years After Elective Percutaneous Coronary Intervention

Davies

Brown

Watson

et al. 2013

Circ: Cardiovascular Interventions

149

121

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Background-Postprocedural myocardial infarction (type 4a) has been shown to be an adverse prognostic indicator after elective percutaneous coronary intervention (PCI). The Cardiac Remote Ischemic Preconditioning in Coronary Stenting (CRISP Stent) study demonstrated that remote ischemic preconditioning reduced procedural symptoms, ECG ST-segment deviation, and cardiac troponin I release after elective PCI and reduced the major adverse cardiac and cerebral event (MACCE) rate at 6 months. We were interested to confirm if this early benefit in MACCE rate in the remote ischemic preconditioning group was sustained long-term. Methods and Results-Patients were telephoned by researchers blinded to the randomization details. MACCE, defined as all-cause mortality, nonfatal myocardial infarction, transient ischemic attack or stroke, and heart failure requiring hospital admission, were adjudicated by case note and national database review. One hundred ninety-two (89.3%) of the 225 patients with elective PCI randomized in the original study were available for long-term follow-up (mean time to event or last follow-up: 1579.7±603.6 days). There were a total of 59 (30.7%) MACCEs. Patients with an MACCE had a higher mean cardiac troponin I after PCI (±SD): 2.07±6.99 versus 0.91±2.07 ng/mL (P=0.05). The MACCE rate at 6 years remained lower in the remote ischemic preconditioning group (hazard ratio, 0.58; 95% confidence interval, 0.35-0.97; P=0.039; absolute risk reduction=0.13 and number needed to treat=8 to prevent the MACCE at 6 years). Conclusions-Remote ischemic preconditioning reduces the incidence of postprocedural cardiac troponin I after elective PCI and confers an MACCE-free survival benefit at both short-and long-term follow-up. Clinical Trial Registration-URL: http://www.ukcrn.org.uk. Unique identifier: UKCRN 4074 (Circ Cardiovasc Interv.2013;6:246-251.)

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“…Deftereos et al recently provided additional evidence that remote ischemic postconditioning may also be effective in preventing acute kidney damage in intermediate-risk patients (mean Mehran risk score 10). 72 The authors evaluated the renoprotective effect of remote ischemic postconditioning in patients with a non-ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention (N5225). In the intervention group, four 1-minute cycles were performed, each consisting of 30-second inflation of the stent balloon and 30-second deflation.…”

mentioning

confidence: 99%

Remote Ischemic Preconditioning and Renoprotection

Gassanov¹,

Nia

Caglayan³

et al. 2014

Journal of the American Society of Nephrology

122

106

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There is currently no effective prophylactic regimen available to prevent contrastinduced AKI (CI-AKI), a frequent and life-threatening complication after cardiac catheterization. Therefore, novel treatment strategies are required to decrease CI-AKI incidence and to improve clinical outcomes in these patients. Remote ischemic preconditioning (rIPC), defined as transient brief episodes of ischemia at a remote site before a subsequent prolonged ischemia/reperfusion injury of the target organ, is an adaptational response that protects against ischemic and reperfusion insult. Indeed, several studies demonstrated the tissue-protective effects of rIPC in various target organs, including the kidneys. In this regard, rIPC may offer a novel noninvasive and virtually cost-free treatment strategy for decreasing CI-AKI incidence. This review evaluates the current experimental and clinical evidence for rIPC as a potential renoprotective strategy, and discusses the underlying mechanisms and key areas for future research.

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Renoprotective Effect of Remote Ischemic Post-Conditioning by Intermittent Balloon Inflations in Patients Undergoing Percutaneous Coronary Intervention

Cited by 86 publications

References 22 publications

Remote Ischemic Postconditioning During Percutaneous Coronary Interventions

Remote Ischemic Postconditioning During Percutaneous Coronary Interventions

Remote Ischemic Preconditioning Improves Outcome at 6 Years After Elective Percutaneous Coronary Intervention

Remote Ischemic Preconditioning and Renoprotection

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