Sheldon Cheskes1, Maria Koh2, Linda Turner3, Ronald Heslegrave4, Richard Verbeek5, Paul Dorian6, Damon C Scales7, Bob Singh8, Shy Amlani4, Madhu Natarajan9, Laurie J Morrison10, Priya Kakar11, Roman Nowickyj12, Michael Lawrence8, Jennifer Cameron4, Dennis T Ko13. 1. Division of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Centre for Prehospital Medicine, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St Michaels Hospital, Toronto, Ontario, Canada. Electronic address: sheldon.cheskes@sunnybrook.ca. 2. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. 3. Sunnybrook Centre for Prehospital Medicine, Toronto, Ontario, Canada. 4. William Osler Health System, Brampton, Ontario, Canada. 5. Sunnybrook Centre for Prehospital Medicine, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 6. Department of Medicine, University of Toronto, Toronto, Ontario, Canada; St Michaels Hospital, Toronto, Ontario, Canada. 7. Li Ka Shing Knowledge Institute, St Michaels Hospital, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 8. Trillium Health Partners, Mississauga, Ontario, Canada. 9. McMaster University, Hamilton, Ontario, Canada. 10. Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 11. Peel Regional Paramedic Service, Ontario, Canada. 12. Halton Region Paramedic Service, Ontario, Canada. 13. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Remote ischemic conditioning (RIC) is a noninvasive therapeutic strategy that uses brief cycles of blood pressure cuff inflation and deflation to protect the myocardium against ischemia-reperfusion injury. We sought to compare major adverse cardiovascular events (MACE) for patients who received RIC before PCI for ST-segment-elevation myocardial infarction (STEMI) compared with standard care. METHODS: We conducted a pre- and postimplementation study. In the preimplementation phase, STEMI patients were taken directly to the PCI lab. After implementation, STEMI patients received 4 cycles of RIC by paramedics or emergency department staff before PCI. The primary outcome was MACE at 90 days. Secondary outcomes included MACE at 30, 60, and 180 days. Inverse probability of treatment weighting using propensity scores estimated causal effects independent from baseline covariables. RESULTS: A total of 1667 (866 preimplementation, 801 postimplementation) patients were included. In the preimplementation phase, 13.4% had MACE at 90 days compared with 11.8% in the postimplementation phase (odds ratio [OR] 0.86, 95% CI 0.62-1.21). There were no significant differences in MACE at 30, 60, and 180 days. Patients presenting with cardiogenic shock or cardiac arrest before PCI were less likely to have MACE at 90 days (42.7% pre vs 27.8% post) if they received RIC before PCI (OR 0.52, 95% CI 0.27-0.98). CONCLUSIONS: A strategy of RIC before PCI for STEMI did not reduce 90-day MACE. Future research should explore the impact of RIC before PCI for longer-term clinical outcomes and for patients presenting with cardiogenic shock or cardiac arrest.
BACKGROUND: Remote ischemic conditioning (RIC) is a noninvasive therapeutic strategy that uses brief cycles of blood pressure cuff inflation and deflation to protect the myocardium against ischemia-reperfusion injury. We sought to compare major adverse cardiovascular events (MACE) for patients who received RIC before PCI for ST-segment-elevation myocardial infarction (STEMI) compared with standard care. METHODS: We conducted a pre- and postimplementation study. In the preimplementation phase, STEMI patients were taken directly to the PCI lab. After implementation, STEMI patients received 4 cycles of RIC by paramedics or emergency department staff before PCI. The primary outcome was MACE at 90 days. Secondary outcomes included MACE at 30, 60, and 180 days. Inverse probability of treatment weighting using propensity scores estimated causal effects independent from baseline covariables. RESULTS: A total of 1667 (866 preimplementation, 801 postimplementation) patients were included. In the preimplementation phase, 13.4% had MACE at 90 days compared with 11.8% in the postimplementation phase (odds ratio [OR] 0.86, 95% CI 0.62-1.21). There were no significant differences in MACE at 30, 60, and 180 days. Patients presenting with cardiogenic shock or cardiac arrest before PCI were less likely to have MACE at 90 days (42.7% pre vs 27.8% post) if they received RIC before PCI (OR 0.52, 95% CI 0.27-0.98). CONCLUSIONS: A strategy of RIC before PCI for STEMI did not reduce 90-day MACE. Future research should explore the impact of RIC before PCI for longer-term clinical outcomes and for patients presenting with cardiogenic shock or cardiac arrest.
Authors: Nicolas Herrera-Zelada; Ursula Zuñiga-Cuevas; Andres Ramirez-Reyes; Sergio Lavandero; Jaime A Riquelme Journal: Front Pharmacol Date: 2021-02-02 Impact factor: 5.810