Steven K White1, Georg M Frohlich2, Daniel M Sado2, Viviana Maestrini2, Marianna Fontana2, Thomas A Treibel2, Shana Tehrani2, Andrew S Flett3, Pascal Meier2, Cono Ariti4, John R Davies5, James C Moon2, Derek M Yellon6, Derek J Hausenloy7. 1. The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, National Institute of Health Research University College London Hospitals Biomedical Research Centre, University College London, London, United Kingdom; The Heart Hospital, London, United Kingdom. 2. The Heart Hospital, London, United Kingdom. 3. Department of Cardiology, University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom. 4. London School of Hygiene and Tropical Medicine, London, United Kingdom. 5. The Essex Cardiothoracic Centre, Basildon University Hospital, Nethermayne, Basildon, Essex, United Kingdom. 6. The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, National Institute of Health Research University College London Hospitals Biomedical Research Centre, University College London, London, United Kingdom. 7. The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, National Institute of Health Research University College London Hospitals Biomedical Research Centre, University College London, London, United Kingdom; The Heart Hospital, London, United Kingdom. Electronic address: d.hausenloy@ucl.ac.uk.
Abstract
OBJECTIVES: This study aimed to determine whether remote ischemic conditioning (RIC) initiated prior to primary percutaneous coronary intervention (PPCI) could reduce myocardial infarct (MI) size in patients presenting with ST-segment elevation myocardial infarction. BACKGROUND: RIC, using transient limb ischemia and reperfusion, can protect the heart against acute ischemia-reperfusion injury. Whether RIC can reduce MI size, assessed by cardiac magnetic resonance (CMR), is unknown. METHODS: We randomly assigned 197 ST-segment elevation myocardial infarction patients with TIMI (Thrombolysis In Myocardial Infarction) flow grade 0 to receive RIC (four 5-min cycles of upper arm cuff inflation/deflation) or control (uninflated cuff placed on upper arm for 40 min) protocols prior to PPCI. The primary study endpoint was MI size, measured by CMR in 83 subjects on days 3 to 6 after admission. RESULTS: RIC reduced MI size by 27%, when compared with the MI size of control subjects (18.0 ± 10% [n = 40] vs. 24.5 ± 12.0% [n = 43]; p = 0.009). At 24 h, high-sensitivity troponin T was lower with RIC (2,296 ± 263 ng/l [n = 89] vs. 2,736 ± 325 ng/l [n = 84]; p = 0.037). RIC also reduced the extent of myocardial edema measured by T2-mapping CMR (28.5 ± 9.0% vs. 35.1 ± 10.0%; p = 0.003) and lowered mean T2 values (68.7 ± 5.8 ms vs. 73.1 ± 6.1 ms; p = 0.001), precluding the use of CMR edema imaging to correctly estimate the area at risk. Using CMR-independent coronary angiography jeopardy scores to estimate the area at risk, RIC, when compared with the control protocol, was found to significantly improve the myocardial salvage index (0.42 ± 0.29 vs. 0.28 ± 0.29; p = 0.03). CONCLUSIONS: This randomized study demonstrated that in ST-segment elevation myocardial infarction patients treated by PPCI, RIC, initiated prior to PPCI, reduced MI size, increased myocardial salvage, and reduced myocardial edema.
OBJECTIVES: This study aimed to determine whether remote ischemic conditioning (RIC) initiated prior to primary percutaneous coronary intervention (PPCI) could reduce myocardial infarct (MI) size in patients presenting with ST-segment elevation myocardial infarction. BACKGROUND: RIC, using transient limb ischemia and reperfusion, can protect the heart against acute ischemia-reperfusion injury. Whether RIC can reduce MI size, assessed by cardiac magnetic resonance (CMR), is unknown. METHODS: We randomly assigned 197 ST-segment elevation myocardial infarction patients with TIMI (Thrombolysis In Myocardial Infarction) flow grade 0 to receive RIC (four 5-min cycles of upper arm cuff inflation/deflation) or control (uninflated cuff placed on upper arm for 40 min) protocols prior to PPCI. The primary study endpoint was MI size, measured by CMR in 83 subjects on days 3 to 6 after admission. RESULTS: RIC reduced MI size by 27%, when compared with the MI size of control subjects (18.0 ± 10% [n = 40] vs. 24.5 ± 12.0% [n = 43]; p = 0.009). At 24 h, high-sensitivity troponin T was lower with RIC (2,296 ± 263 ng/l [n = 89] vs. 2,736 ± 325 ng/l [n = 84]; p = 0.037). RIC also reduced the extent of myocardial edema measured by T2-mapping CMR (28.5 ± 9.0% vs. 35.1 ± 10.0%; p = 0.003) and lowered mean T2 values (68.7 ± 5.8 ms vs. 73.1 ± 6.1 ms; p = 0.001), precluding the use of CMR edema imaging to correctly estimate the area at risk. Using CMR-independent coronary angiography jeopardy scores to estimate the area at risk, RIC, when compared with the control protocol, was found to significantly improve the myocardial salvage index (0.42 ± 0.29 vs. 0.28 ± 0.29; p = 0.03). CONCLUSIONS: This randomized study demonstrated that in ST-segment elevation myocardial infarction patients treated by PPCI, RIC, initiated prior to PPCI, reduced MI size, increased myocardial salvage, and reduced myocardial edema.
Authors: Derek J Hausenloy; William Chilian; Filippo Crea; Sean M Davidson; Peter Ferdinandy; David Garcia-Dorado; Niels van Royen; Rainer Schulz; Gerd Heusch Journal: Cardiovasc Res Date: 2019-06-01 Impact factor: 10.787
Authors: Thomas Engstrøm; Henning Kelbæk; Steffen Helqvist; Dan Eik Høfsten; Lene Kløvgaard; Peter Clemmensen; Lene Holmvang; Erik Jørgensen; Frants Pedersen; Kari Saunamaki; Jan Ravkilde; Hans-Henrik Tilsted; Anton Villadsen; Jens Aarøe; Svend Eggert Jensen; Bent Raungaard; Hans E Bøtker; Christian J Terkelsen; Michael Maeng; Anne Kaltoft; Lars R Krusell; Lisette O Jensen; Karsten T Veien; Klaus Fuglsang Kofoed; Christian Torp-Pedersen; Kasper Kyhl; Lars Nepper-Christensen; Marek Treiman; Niels Vejlstrup; Kiril Ahtarovski; Jacob Lønborg; Lars Køber Journal: JAMA Cardiol Date: 2017-05-01 Impact factor: 14.676
Authors: Peter Nørkjær Laursen; L Holmvang; H Kelbæk; N Vejlstrup; T Engstrøm; J Lønborg Journal: Clin Res Cardiol Date: 2017-02-06 Impact factor: 5.460