Ingo Eitel1, Thomas Stiermaier2, Karl P Rommel2, Georg Fuernau3, Marcus Sandri2, Norman Mangner2, Axel Linke2, Sandra Erbs2, Phillip Lurz2, Enno Boudriot2, Meinhard Mende4, Steffen Desch3, Gerhard Schuler2, Holger Thiele3. 1. University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany ingoeitel@gmx.de. 2. Department of Internal Medicine/Cardiology, University of Leipzig - Heart Center, Leipzig, Germany. 3. University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany. 4. Clinical Trial Center Leipzig, University of Leipzig, Leipzig, Germany.
Abstract
AIMS: Remote ischaemic conditioning (RIC) and postconditioning (PostC) are both potent activators of innate protection against ischaemia-reperfusion injury and have demonstrated cardioprotection in experimental and clinical ST-elevation myocardial infarction (STEMI) trials. However, their combined effects have not been studied in detail. The aim of this study was to evaluate if the co-application of intrahospital RIC and PostC has a more powerful effect on myocardial salvage compared with either PostC alone or control. METHODS AND RESULTS: This prospective, controlled, single-centre study randomized 696 STEMI patients to one of the following three groups: (i) combined intrahospital RIC + PostC in addition to primary percutaneous coronary intervention (PCI); (ii) PostC in addition to PCI; and (iii) conventional PCI (control). The primary endpoint myocardial salvage index was assessed by cardiac magnetic resonance (CMR) imaging within 3 days after infarction. Secondary endpoints included infarct size and microvascular obstruction (MVO) assessed by CMR. The combined clinical endpoint consisted of death, reinfarction, and new congestive heart failure within 6 months. The primary endpoint myocardial salvage index was significantly greater in the combined RIC + PostC group when compared with the control group (49 [interquartile range 30-72] vs. 40 [interquartile range 16-68], P = 0.02). Postconditioning alone failed to improve myocardial salvage when compared with conventional PCI (P = 0.39). The secondary endpoints, including infarct size and MVO, showed no significant differences between groups. Clinical follow-up at 6 months revealed no differences in the combined clinical endpoint between groups (P = 0.44). CONCLUSION: Combined intrahospital RIC + PostC in conjunction with PCI in STEMI significantly improves myocardial salvage in comparison with control and PostC. CLINICALTRIALSGOV: NCT02158468. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Remote ischaemic conditioning (RIC) and postconditioning (PostC) are both potent activators of innate protection against ischaemia-reperfusion injury and have demonstrated cardioprotection in experimental and clinical ST-elevation myocardial infarction (STEMI) trials. However, their combined effects have not been studied in detail. The aim of this study was to evaluate if the co-application of intrahospital RIC and PostC has a more powerful effect on myocardial salvage compared with either PostC alone or control. METHODS AND RESULTS: This prospective, controlled, single-centre study randomized 696 STEMI patients to one of the following three groups: (i) combined intrahospital RIC + PostC in addition to primary percutaneous coronary intervention (PCI); (ii) PostC in addition to PCI; and (iii) conventional PCI (control). The primary endpoint myocardial salvage index was assessed by cardiac magnetic resonance (CMR) imaging within 3 days after infarction. Secondary endpoints included infarct size and microvascular obstruction (MVO) assessed by CMR. The combined clinical endpoint consisted of death, reinfarction, and new congestive heart failure within 6 months. The primary endpoint myocardial salvage index was significantly greater in the combined RIC + PostC group when compared with the control group (49 [interquartile range 30-72] vs. 40 [interquartile range 16-68], P = 0.02). Postconditioning alone failed to improve myocardial salvage when compared with conventional PCI (P = 0.39). The secondary endpoints, including infarct size and MVO, showed no significant differences between groups. Clinical follow-up at 6 months revealed no differences in the combined clinical endpoint between groups (P = 0.44). CONCLUSION: Combined intrahospital RIC + PostC in conjunction with PCI in STEMI significantly improves myocardial salvage in comparison with control and PostC. CLINICALTRIALSGOV: NCT02158468. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Seyed Mohammad Seyedsaadat; Leonardo Rangel Castilla; Giuseppe Lanzino; Harry J Cloft; Daniel J Blezek; Amy Theiler; Ramanathan Kadirvel; Waleed Brinjikji; David F Kallmes Journal: Neuroradiol J Date: 2019-04-03
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: Rolf A Blauenfeldt; Niels Hjort; Martin F Gude; Anne B Behrndtz; Marc Fisher; Jan B Valentin; Hans Kirkegaard; Søren P Johnsen; David C Hess; Grethe Andersen Journal: Eur Stroke J Date: 2019-10-25