Cardio- and reno-protective effect of remote ischemic preconditioning in patients undergoing percutaneous coronary intervention. A prospective, non-randomized controlled trial

Abstract

AbstractObjectivesThis study assessed the cardio- and renoprotective effect of remote ischemic Preconditioning (PreC) in patients undergoing percutaneous coronary intervention (PCI).BackgroundMyocyte necrosis and contrast induced nephropathy (CIN) occur frequently in PCI and are associated with subsequent cardiovascular events. Methods: Two hundred consecutive patients undergoing elective PCI with normal baseline troponin-I (cTnI) values were recruited. Subjects were systematically allocated into 2 groups: 100 patients received PreC (created by three 5min inflations of a blood pressure cuff to 200mmHg around the upper arm, separated by 5min intervals of reperfusion) <2h before the PCI procedure, and control group (n=100).ResultsThe incidence of PCI-related myocardial infarction (MI 4a) at 24h after PCI was lower in the PreC group compared with control group (41% vs 64%, P=0.02). Subjects who received PreC had significant trend toward lower incidence of CIN at 72h after contrast exposure (4 vs. 11, P=0.05) and less chest pain during stent implantation compared to control group. At 3 months, the major adverse event rate was lower in the PreC group (6 vs. 14 events; P=0.04).ConclusionsThe use of PreC<2h before PCI, reduces the incidence of PCI-related MI 4a, tends to decrease the incidence of CIN and improves ischemic symptoms in patients undergoing elective PCI. The observed cardio- and renoprotection appears to confer sustained benefit on reduced major adverse events at 3 month follow-up beyond what is seen with judicious pre- and post-hydration (ClinicalTrials.gov identifier: NCT02313441)