Remote Ischemic Postconditioning: Does It Protect Against Ischemic Damage in Percutaneous Coronary Revascularization? Randomized Placebo-Controlled Clinical Trial

Study Questions:

What is the effect of remote ischemic postconditioning (RIP) on percutaneous coronary intervention-related myocardial infarction (PCI-MI)?

Methods:

This was a single-center, randomized, blinded to the researchers, clinical trial at a tertiary hospital center. A total of 232 patients underwent elective PCI for stable or unstable angina. Patients were randomized to RIP (induction of three 5-minute cycles of ischemia in the arm after the PCI) versus placebo. The primary outcome measure was the peak 24-hour troponin I level. PCI-MI was defined by an elevation of troponin values >3 or >5 of the 99th percentile according to the classical or the new definition. The secondary outcome measure was hospital admission, PCI for stable angina or acute coronary syndrome, and mortality after 1 year of follow-up. The use of RIP in diabetic patients was specifically studied.

Results:

The mean age was 64.6 years, and 42% were diabetic. The peak troponin in the RIP patients was 0.476 versus 0.478 ng/ml (p = 0.99). PCI-MI occurred in 36% of the RIP patients versus 30.8% in the placebo group (p = 0.378). Diabetic RIP patients had more PCI-MI (new definition): odds ratio, 2.7; 95% confidence interval, 1.10-6.92; p = 0.027. The secondary outcome measure was seen in 11.7% of the RIP patients versus 10.8% in the placebo group (p = 0.907).

Conclusions:

The authors concluded that RIP did not reduce the damage associated with elective PCI or cardiovascular events during the follow-up.

Perspective:

This prospective, randomized, controlled trial demonstrates that RIP, administered by transient upper-limb ischemia, does not affect PCI-related troponin release in patients undergoing elective PCI. Furthermore, among those randomized to the RIP, diabetes was associated with a 37% increase in the peak troponin levels compared with the nondiabetic patients, and the application of the new definition of PCI-MI resulted in a greater and significant incidence of PCI-MI in the diabetic patients who underwent RIP as compared with the controls. While the harm noted among diabetic patients needs further study, the future for RPI does not look promising.

Clinical Topics: Acute Coronary Syndromes, Invasive Cardiovascular Angiography and Intervention, Interventions and ACS

Keywords: Incidence, Myocardial Infarction, Acute Coronary Syndrome, Follow-Up Studies, Troponin I, Angioplasty, Balloon, Coronary, Ischemic Postconditioning, Troponin, Percutaneous Coronary Intervention


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