Author + information
- Jing Gao,
- Fen Liu,
- Yining Yang,
- Xiaomei Li,
- Jiajun Zhu and
- Yitong Ma
Limiting infarct size at the acute phase is a clinical goal. Cardiac ischemic-reperfusion (IR) injury following percutaneous coronary intervention (PCI) has become a hurdle in improving patient outcome. We investigate whether remote ischemic per-conditioning (RIPerC) performed in patients with ST-segment elevation myocardial infarction (STEMI) before PCI would reduce infarct size.
STEMI patients were recruited and randomly allocated to two groups: (1) control group (n=66), PCI alone; (2) RIPerC group (n=60), RIPerC combined with PCI, consisting of three cycles of 5 min inflation and 5 min deflation of the left lower limb blood pressure cuff performed before reperfusion. Serial plasma levels of creatine kinase-MB isoenzyme (CK-MB) during 72h following admission were measured as a surrogate marker of infarct size.
Overall, the area under curve (AUC) of CK-MB was comparable between RIPerC and control groups (6179 ± 437.9 vs. 8130 ± 534.7 a.u., P=0.006). There was also significant difference in the peak CK-MB level bwteen the two groups (281.8 ± 22.33 U/L vs. 368.8 ± 24.96U/L, P=0.011). Interestingly, In the subgroup of patients,whose infarct-related artery were left anterior descending (LAD),CK-MB AUC (6263 ± 487.7 vs. 8268 ± 749.6 a.u., P = 0.037) and peak CK-MB (304.8 ± 28.57 vs. 392.5 ± 32.76U/L, P = 0.047) was significantly reduced in the RIPerC in comparison to the control group. The negative outcome was observed in patients whose infarct-related artery were not LAD,but RCA or LCX. ST-segment resolution >50% was 76.7% in RIPerC and 59.1% in control subjects (P= 0.035). We observed no significant differences in TIMI frame count after PCI.
RIPerC of the Lower Limb prior to PCI reduced enzymatic infarct size in STEMI patients, especially in patients with a culprit vessel of LAD.