Thomas Stiermaier1,2, Jan-Oluf Jensen1,2, Karl-Philipp Rommel3, Suzanne de Waha-Thiele1,2, Georg Fuernau1,2, Steffen Desch2,3, Holger Thiele3, Ingo Eitel1,2. 1. From the University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Germany (T.S., J.-O.J., S.d.W.-T., G.F., I.E.). 2. German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany (T.S., J.-O.J., S.d.W.-T., G.F., S.D., I.E.). 3. Heart Center Leipzig, University Hospital, Department of Internal Medicine/Cardiology, Germany (K.-P.R., S.D., H.T.).
Abstract
RATIONALE: Remote ischemic conditioning (RIC) or ischemic postconditioning (PostC) may protect the myocardium from ischemia-reperfusion injury in patients with ST-segment-elevation myocardial infarction. OBJECTIVE: To determine whether combined intrahospital RIC and PostC or PostC alone in addition to primary percutaneous coronary intervention (PCI) reduce long-term clinical events after ST-segment-elevation myocardial infarction. METHODS AND RESULTS: The present study is a post hoc analysis of a prospective trial which randomized 696 ST-segment-elevation myocardial infarction patients with symptoms <12 hours 1:1:1 to eithercombined RIC and PostC in addition to primary PCI, PostC alone in addition to primary PCI, or conventional PCI (control). Three cycles of RIC were performed by inflation of an upper arm blood pressure cuff for 5 minutes followed by deflation for 5 minutes. PostC was performed after primary PCI via 4 cycles of 30 seconds balloon occlusions followed by 30 seconds of reperfusion. Major adverse cardiac events consisting of cardiac death, reinfarction, and new congestive heart failure were assessed during long-term follow-up. Follow-up data were obtained in 97% of patients in median 3.6 years after the index event (interquartile range, 2.9-4.2 years). Major adverse cardiac events occurred in 10.2% of patients in the combined RIC and PostC group and in 16.9% in the control group (odds ratio, 0.56; 95% CI, 0.32-0.97; P=0.04). The difference was driven by a significantly reduced rate of new congestive heart failure in the RIC and PostC group (2.7% versus 7.8%; odds ratio, 0.32; 95% CI, 0.13-0.84; P=0.02). In contrast, PostC alone did not reduce major adverse cardiac events compared with controls (14.1% versus 16.9%; odds ratio, 0.81; 95% CI, 0.48-1.35; P=0.41), and the reduction of new congestive heart failure was not statistically significant (3.5% versus 7.8%; odds ratio, 0.43; 95% CI, 0.18-1.03; P=0.05). CONCLUSIONS: Cardioprotection by combined intrahospital RIC and PostC in addition to primary PCI significantly reduced the rate of major adverse cardiac events and new congestive heart failure after ST-segment-elevation myocardial infarction. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov . Unique identifier: NCT02158468.
RCT Entities:
RATIONALE: Remote ischemic conditioning (RIC) or ischemic postconditioning (PostC) may protect the myocardium from ischemia-reperfusion injury in patients with ST-segment-elevation myocardial infarction. OBJECTIVE: To determine whether combined intrahospital RIC and PostC or PostC alone in addition to primary percutaneous coronary intervention (PCI) reduce long-term clinical events after ST-segment-elevation myocardial infarction. METHODS AND RESULTS: The present study is a post hoc analysis of a prospective trial which randomized 696 ST-segment-elevation myocardial infarctionpatients with symptoms <12 hours 1:1:1 to either combined RIC and PostC in addition to primary PCI, PostC alone in addition to primary PCI, or conventional PCI (control). Three cycles of RIC were performed by inflation of an upper arm blood pressure cuff for 5 minutes followed by deflation for 5 minutes. PostC was performed after primary PCI via 4 cycles of 30 seconds balloon occlusions followed by 30 seconds of reperfusion. Major adverse cardiac events consisting of cardiac death, reinfarction, and new congestive heart failure were assessed during long-term follow-up. Follow-up data were obtained in 97% of patients in median 3.6 years after the index event (interquartile range, 2.9-4.2 years). Major adverse cardiac events occurred in 10.2% of patients in the combined RIC and PostC group and in 16.9% in the control group (odds ratio, 0.56; 95% CI, 0.32-0.97; P=0.04). The difference was driven by a significantly reduced rate of new congestive heart failure in the RIC and PostC group (2.7% versus 7.8%; odds ratio, 0.32; 95% CI, 0.13-0.84; P=0.02). In contrast, PostC alone did not reduce major adverse cardiac events compared with controls (14.1% versus 16.9%; odds ratio, 0.81; 95% CI, 0.48-1.35; P=0.41), and the reduction of new congestive heart failure was not statistically significant (3.5% versus 7.8%; odds ratio, 0.43; 95% CI, 0.18-1.03; P=0.05). CONCLUSIONS: Cardioprotection by combined intrahospital RIC and PostC in addition to primary PCI significantly reduced the rate of major adverse cardiac events and new congestive heart failure after ST-segment-elevation myocardial infarction. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov . Unique identifier: NCT02158468.
Authors: Bruno García Del Blanco; Imanol Otaegui; José F Rodríguez-Palomares; Antoni Bayés-Genis; Eduard Fernández-Nofrerías; Victoria Vilalta Del Olmo; Xavier Carrillo; Borja Ibáñez; Fernando Worner; Juan Casanova; Eva Pueo; Jose R González-Juanatey; Javier López-Pais; Alfredo Bardají; Gil Bonet; Mónica Fuertes; Antonio Rodríguez-Sinovas; Marisol Ruiz-Meana; Javier Inserte; Ignasi Barba; Sandra Gómez-Talavera; Gerard Martí; Bernat Serra; Neus Bellera; Manuel Ojeda-Ramos; Hug Cuellar; Filipa Valente; Maria Ángeles Carmona; Elisabet Miró-Casas; Josep R Marsal; Antonia Sambola; Rosa M Lidón; Jordi Bañeras; Jaime Elízaga; Ferran Padilla; José A Barrabés; Derek J Hausenloy; Ignacio Ferreira-González; David García-Dorado Journal: Basic Res Cardiol Date: 2021-01-25 Impact factor: 17.165
Authors: J Ranjit Arnold; Andrew P Vanezis; Glenn C Rodrigo; Florence Y Lai; Prathap Kanagala; Sheraz Nazir; Jamal N Khan; Leong Ng; Kamal Chitkara; J Gerry Coghlan; Simon Hetherington; Nilesh J Samani; Gerald P McCann Journal: Basic Res Cardiol Date: 2022-04-23 Impact factor: 12.416