Long-term Results of One Cycle of Remote Ischemic Preconditioning Applied Before Elective Percutaneous Coronary Intervention

Abstract

Introduction: Myocardial injury after percutaneous coronary intervention (PCI) is seen frequently. Ischemia/reperfusion injury, side branch occlusion and distal embolization of atherothrombotic debris are the main causes of myocardial injury. Remote ischemic preconditioning (RIPC) is a promising technique for protection from ischemia/reperfusion injury, but sufficient data of long-term clinical outcomes is not available. In this study we planned to investigate the effect of one cycle of RIPC on major cardiovascular events one year after elective PCI. Patients and Methods: 102 patients, undergoing elective PCI, with normal baseline cTroponin-I (cTn-I) values, were randomized equally into two groups. Five minutes of ischemic preconditioning was applied before the intervention to the preconditioning group, by inflating blood pressure cuff up-to 200 mmHg on non-dominant arm. After 1 year, the clinical outcomes of these patients (angina, heart failure, death, myocardial infarction, repeat revascularization) were questioned. Results: From a total of 102 patients, 90 could be reached after an year. The mean duration of follow-up was 432 vs. 423.5 days (p= 0.793). Post-PCI 16th hour cTn-I was insignificantly lower in the preconditioning arm (0.079 μg/L vs. 0.069 μg/L, p= 0.074). The incidence of cTn-I elevation 5 fold above the URL (> 0.115 μg/L) was lower in the preconditioning group; however, it was also insignificant (24.4% vs. 13.3%, p= 0.301). Death, MI or repeat revascularization rates did not differ between the groups.