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Int J Angiol 2017; 26(04): 241-248
DOI: 10.1055/s-0037-1601870
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Impact of Remote Ischemic Postconditioning during Primary Percutaneous Coronary Intervention on Left Ventricular Remodeling after Anterior Wall ST-Segment Elevation Myocardial Infarction: A Single-Center Experience

Ayman Elbadawi
1   Department of Medicine, Rochester General Hospital, Rochester, New York
2   Department of Cardiovascular Diseases, Ain Shams Medical School, Cairo, Egypt
,
Omar Awad
2   Department of Cardiovascular Diseases, Ain Shams Medical School, Cairo, Egypt
,
Ramy Raymond
2   Department of Cardiovascular Diseases, Ain Shams Medical School, Cairo, Egypt
,
Haytham Badran
2   Department of Cardiovascular Diseases, Ain Shams Medical School, Cairo, Egypt
,
Ahmad E. Mostafa
2   Department of Cardiovascular Diseases, Ain Shams Medical School, Cairo, Egypt
,
Marwan Saad
2   Department of Cardiovascular Diseases, Ain Shams Medical School, Cairo, Egypt
3   Division of Cardiovascular Medicine, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
› Author Affiliations
Further Information

Publication History

Publication Date:
28 April 2017 (online)

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Abstract

The role of remote ischemic postconditioning (RIPostC) in improving left ventricular (LV) remodeling after primary percutaneous coronary intervention (PCI) is not well established. To determine the efficacy and safety of RIPostC in improving LV remodeling and cardiovascular outcomes after primary PCI for anterior ST-elevation myocardial infarction (STEMI). Seventy-one patients with anterior STEMI were randomized to primary PCI with RIPostC protocol (n = 36) versus conventional primary PCI (n = 35). Primary outcomes included LV remodeling and LV ejection fraction (LVEF) at 6 month follow-up using transthoracic echocardiography. Secondary outcomes included infarct size, ST-segment resolution (STR) ≥70%, Thrombolysis in Myocardial Infarction (TIMI) flow grade, and myocardial blush grade (MBG). Major adverse cardiac events (MACEs) were also assessed at 6 months. Safety outcome included incidence of acute kidney injury (AKI) postprimary PCI. Sixty patients completed the study. At 6 months, there was no significant decrease in the incidence of LV remodeling with RIPostC group (p = 0.42). Similarly, RIPostC failed to show significant improvement in LVEF. However, STR ≥ 70% after primary PCI was achieved more in the RIPostC group (p = 0.04), with a trend toward less AKI in the RIPostC group (p = 0.08). All other secondary end points, including MACEs at 6 months, were similar in both groups. RIPostC might be associated with better STR after reperfusion as well as less incidence of AKI in patients undergoing primary PCI for anterior wall STEMI, indicating potential benefit in those patients. Whether this role can be translated to better outcomes after primary PCI warrants further investigation.

Keywords

coronary artery disease - acute anterior wall myocardial infarction - primary PCI - reperfusion Injury - remote ischemic postconditioning - remodeling
 

  • References

  • 1 O'Gara PT, Kushner FG, Ascheim DD. , et al; American College of Emergency Physicians; Society for Cardiovascular Angiography and Interventions. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013; 61 (04) e78-e140
    PubMedGoogle Scholar
  • 2 Yellon DM, Hausenloy DJ. Myocardial reperfusion injury. N Engl J Med 2007; 357 (11) 1121-1135
    CrossrefPubMedGoogle Scholar
  • 3 Murry CE, Jennings RB, Reimer KA. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation 1986; 74 (05) 1124-1136
    CrossrefPubMedGoogle Scholar
  • 4 Kharbanda RK, Peters M, Walton B. , et al. Ischemic preconditioning prevents endothelial injury and systemic neutrophil activation during ischemia-reperfusion in humans in vivo. Circulation 2001; 103 (12) 1624-1630
    CrossrefPubMedGoogle Scholar
  • 5 Ishihara M, Sato H, Tateishi H. , et al. Implications of prodromal angina pectoris in anterior wall acute myocardial infarction: acute angiographic findings and long-term prognosis. J Am Coll Cardiol 1997; 30 (04) 970-975
    CrossrefPubMedGoogle Scholar
  • 6 Zhao Z-Q, Corvera JS, Halkos ME. , et al. Inhibition of myocardial injury by ischemic postconditioning during reperfusion: comparison with ischemic preconditioning. Am J Physiol Heart Circ Physiol 2003; 285 (02) H579-H588
    CrossrefPubMedGoogle Scholar
  • 7 Przyklenk K, Bauer B, Ovize M, Kloner RA, Whittaker P. Regional ischemic ‘preconditioning’ protects remote virgin myocardium from subsequent sustained coronary occlusion. Circulation 1993; 87 (03) 893-899
    CrossrefPubMedGoogle Scholar
  • 8 Bøtker HE, Kharbanda R, Schmidt MR. , et al. Remote ischaemic conditioning before hospital admission, as a complement to angioplasty, and effect on myocardial salvage in patients with acute myocardial infarction: a randomised trial. Lancet 2010; 375 (9716): 727-734
    CrossrefPubMedGoogle Scholar
  • 9 Crimi G, Pica S, Raineri C. , et al. Remote ischemic post-conditioning of the lower limb during primary percutaneous coronary intervention safely reduces enzymatic infarct size in anterior myocardial infarction: a randomized controlled trial. JACC Cardiovasc Interv 2013; 6 (10) 1055-1063
    CrossrefPubMedGoogle Scholar
  • 10 Berti V, Sciagrà R, Acampa W. , et al. Relationship between infarct size and severity measured by gated SPECT and long-term left ventricular remodelling after acute myocardial infarction. Eur J Nucl Med Mol Imaging 2011; 38 (06) 1124-1131
    CrossrefPubMedGoogle Scholar
  • 11 Killip III T, Kimball JT. Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol 1967; 20 (04) 457-464
    CrossrefPubMedGoogle Scholar
  • 12 Kessler KM. Ejection fraction derived by M-mode echocardiography: a table and comments. Cathet Cardiovasc Diagn 1979; 5 (03) 295-299
    CrossrefPubMedGoogle Scholar
  • 13 Lang RM, Bierig M, Devereux RB. , et al; Chamber Quantification Writing Group; American Society of Echocardiography's Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18 (12) 1440-1463
    CrossrefPubMedGoogle Scholar
  • 14 Otterstad JE, Froeland G, St John Sutton M, Holme I. Accuracy and reproducibility of biplane two-dimensional echocardiographic measurements of left ventricular dimensions and function. Eur Heart J 1997; 18 (03) 507-513
    CrossrefPubMedGoogle Scholar
  • 15 Carrick D, Haig C, Rauhalammi S. , et al. Pathophysiology of LV remodeling in survivors of STEMI: inflammation, remote myocardium, and prognosis. JACC Cardiovasc Imaging 2015; 8 (07) 779-789
    CrossrefPubMedGoogle Scholar
  • 16 Schröder R. Prognostic impact of early ST-segment resolution in acute ST-elevation myocardial infarction. Circulation 2004; 110 (21) e506-e510
    CrossrefPubMedGoogle Scholar
  • 17 Appleby MA, Angeja BG, Dauterman K, Gibson CM. Angiographic assessment of myocardial perfusion: TIMI myocardial perfusion (TMP) grading system. Heart 2001; 86 (05) 485-486
    CrossrefPubMedGoogle Scholar
  • 18 Henriques JPS, Zijlstra F, van 't Hof AWJ. , et al. Angiographic assessment of reperfusion in acute myocardial infarction by myocardial blush grade. Circulation 2003; 107 (16) 2115-2119
    CrossrefPubMedGoogle Scholar
  • 19 Freixa X, Bellera N, Ortiz-Pérez JT. , et al. Ischaemic postconditioning revisited: lack of effects on infarct size following primary percutaneous coronary intervention. Eur Heart J 2012; 33 (01) 103-112
    CrossrefPubMedGoogle Scholar
  • 20 Tarantini G, Favaretto E, Marra MP. , et al. Postconditioning during coronary angioplasty in acute myocardial infarction: the POST-AMI trial. Int J Cardiol 2012; 162 (01) 33-38
    CrossrefPubMedGoogle Scholar
  • 21 Yang X-M, Philipp S, Downey JM, Cohen MV. Postconditioning's protection is not dependent on circulating blood factors or cells but involves adenosine receptors and requires PI3-kinase and guanylyl cyclase activation. Basic Res Cardiol 2005; 100 (01) 57-63
    CrossrefPubMedGoogle Scholar
  • 22 Wolfrum S, Schneider K, Heidbreder M, Nienstedt J, Dominiak P, Dendorfer A. Remote preconditioning protects the heart by activating myocardial PKCepsilon-isoform. Cardiovasc Res 2002; 55 (03) 583-589
    CrossrefPubMedGoogle Scholar
  • 23 Zatta AJ, Kin H, Lee G. , et al. Infarct-sparing effect of myocardial postconditioning is dependent on protein kinase C signalling. Cardiovasc Res 2006; 70 (02) 315-324
    CrossrefPubMedGoogle Scholar
  • 24 Song YB, Hahn JY, Choi SH. , et al. Sirolimus- versus paclitaxel-eluting stents for the treatment of coronary bifurcations results: from the COBIS (Coronary Bifurcation Stenting) Registry. J Am Coll Cardiol 2010; 55 (16) 1743-1750
    CrossrefPubMedGoogle Scholar
  • 25 Hausenloy DJ, Tsang A, Mocanu MM, Yellon DM. Ischemic preconditioning protects by activating prosurvival kinases at reperfusion. Am J Physiol Heart Circ Physiol 2005; 288 (02) H971-H976
    CrossrefPubMedGoogle Scholar
  • 26 Hausenloy DJ, Maddock HL, Baxter GF, Yellon DM. Inhibiting mitochondrial permeability transition pore opening: a new paradigm for myocardial preconditioning?. Cardiovasc Res 2002; 55 (03) 534-543
    CrossrefPubMedGoogle Scholar
  • 27 Loukogeorgakis SP, Williams R, Panagiotidou AT. , et al. Transient limb ischemia induces remote preconditioning and remote postconditioning in humans by a K(ATP)-channel dependent mechanism. Circulation 2007; 116 (12) 1386-1395
    CrossrefPubMedGoogle Scholar
  • 28 Rentoukas I, Giannopoulos G, Kaoukis A. , et al. Cardioprotective role of remote ischemic periconditioning in primary percutaneous coronary intervention: enhancement by opioid action. JACC Cardiovasc Interv 2010; 3 (01) 49-55
    CrossrefPubMedGoogle Scholar
  • 29 Andreka G, Vertesaljai M, Szantho G. , et al. Remote ischaemic postconditioning protects the heart during acute myocardial infarction in pigs. Heart 2007; 93 (06) 749-752
    CrossrefPubMedGoogle Scholar
  • 30 de Lemos JA, Antman EM, Giugliano RP. , et al. ST-segment resolution and infarct-related artery patency and flow after thrombolytic therapy. Thrombolysis in Myocardial Infarction (TIMI) 14 investigators. Am J Cardiol 2000; 85 (03) 299-304
    CrossrefPubMedGoogle Scholar
  • 31 Crimi G, Ferlini M, Gallo F. , et al. Remote ischemic postconditioning as a strategy to reduce acute kidney injury during primary PCI: a post-hoc analysis of a randomized trial. Int J Cardiol 2014; 177 (02) 500-502
    CrossrefPubMedGoogle Scholar
  • 32 Deftereos S, Giannopoulos G, Tzalamouras V. , et al. Renoprotective effect of remote ischemic post-conditioning by intermittent balloon inflations in patients undergoing percutaneous coronary intervention. J Am Coll Cardiol 2013; 61 (19) 1949-1955
    CrossrefPubMedGoogle Scholar