Remote Ischemic Conditioning in Patients With Myocardial Infarction Treated With Primary Angioplasty
Open Access
- 1 November 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation: Cardiovascular Imaging
- Vol. 3 (6), 656-662
- https://doi.org/10.1161/circimaging.110.957340
Abstract
Background—: We have found that remote ischemic conditioning (rIC), adjunctive to primary angioplasty, increases myocardial salvage in patients with ST-segment elevation myocardial infarction (STEMI) and extensive myocardial area at risk (AAR). The present substudy aimed to evaluate the short-term effects of rIC on left ventricular (LV) function. Methods and Results—: Patients with a first STEMI were randomized to rIC (4 cycles of 5 minutes upper-limb ischemia) during transfer to primary percutaneous coronary intervention (pPCI) (n=123) versus pPCI alone (n=119). Ejection fraction (EF), LV volumes, (2D and 3D echocardiography and myocardial perfusion imaging), and speckle-tracking global longitudinal strain were compared between treatment groups. There was no significant difference in LV function at day 1 (EF-2D, 0.51±0.10 versus 0.49±0.10; P =0.22) and after 30 days (EF-2D, 0.54±0.08 versus 0.53±0.10) between the rIC and the pPCI-alone groups. In patients with extensive AAR ≥35% of LV (n=53), EF after 30 days was higher after rIC than after pPCI alone (EF-2D, 0.51±0.07 versus 0.46±0.09; P =0.05). In patients with anterior infarction (n=97), rIC preserved LV function on day 1 (EF-2D, 0.51±0.11 versus 0.46±0.11; P =0.03) and persistently after 30 days (EF-2D, 0.55±0.08 versus 0.50±0.11; P =0.04; EF-myocardial perfusion imaging, 0.55±0.10 versus 0.49±0.12; P =0.02). These patients had similar AAR, whereas rIC reduced infarct size from 16% to 7% of LV ( P =0.01). Conclusions—: Although no significant overall effect was observed, rIC seemed to result in modest improvement in LV function in high-risk patients prone to develop large myocardial infarcts. These results need to be confirmed in larger trials. Clinical Trial Registration—: URL: http://www.clinicaltrials.gov . Unique identifier: NCT00435266.Keywords
This publication has 29 references indexed in Scilit:
- Remote ischaemic conditioning before hospital admission, as a complement to angioplasty, and effect on myocardial salvage in patients with acute myocardial infarction: a randomised trialThe Lancet, 2010
- Comparison of Left Ventricular Ejection Fraction and Left Ventricular Global Strain as Determinants of Infarct Size in Patients with Acute Myocardial InfarctionJournal of the American Society of Echocardiography, 2009
- Translation of remote ischaemic preconditioning into clinical practiceThe Lancet, 2009
- Timing, Causes, and Predictors of Death After Three Years' Follow-Up in the Danish Multicenter Randomized Study of Fibrinolysis Versus Primary Angioplasty in Acute Myocardial Infarction (DANAMI-2) TrialThe American Journal of Cardiology, 2009
- Infarct size and myocardial salvage after primary angioplasty in patients presenting with symptoms for <12 h vs. 12-72 hEuropean Heart Journal, 2009
- Use of myocardial strain to assess global left ventricular function: A comparison with cardiac magnetic resonance and 3-dimensional echocardiographyAmerican Heart Journal, 2009
- Noninvasive Separation of Large, Medium, and Small Myocardial Infarcts in Survivors of Reperfused ST-Elevation Myocardial InfarctionCirculation: Cardiovascular Imaging, 2008
- Global longitudinal strain measured by two-dimensional speckle tracking echocardiography is closely related to myocardial infarct size in chronic ischaemic heart diseaseClinical Science, 2007
- A Comparison of Coronary Angioplasty with Fibrinolytic Therapy in Acute Myocardial InfarctionThe New England Journal of Medicine, 2003
- The prognostic value of predischarge quantitative two-dimensional echocardiographic measurements and the effects of early lisinopril treatment on left ventricular structure and function after acute myocardial infarction in the GISSI-3 TrialEuropean Heart Journal, 1996