Letter by Olafiranye Regarding Article "Combined Intrahospital Remote Ischemic Perconditioning and Postconditioning Improves Clinical Outcome in ST-Elevation Myocardial Infarction: Long-Term Results of the LIPSIA CONDITIONING Trial".
Letter by Olafiranye Regarding Article "Combined Intrahospital Remote Ischemic Perconditioning and Postconditioning Improves Clinical Outcome in ST-Elevation Myocardial Infarction: Long-Term Results of the LIPSIA CONDITIONING Trial".
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Olafiranye 关于文章“院内远程缺血预处理和后处理相结合可改善 ST 段抬高型心肌梗死的临床结果：LIPSIA 调理试验的长期结果”的信函。
DOI：
10.1161/circresaha.119.315526
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发表时间：
2019
影响因子：
20.1
通讯作者：
Olafiranye,Oladipupo
中科院分区：
文献类型：
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作者：
Olafiranye,Oladipupo
我怀着极大的兴趣读了斯蒂尔迈尔等人写的文章。Stiermaier等人对一项前瞻性、随机、开放标签、对照的LIPSIA预处理试验进行了长期临床随访和事后分析，该试验在ST段抬高型心肌梗死（STEMI）患者中联合进行了院内远程缺血预处理和后处理。2该研究将德国696例症状< 12小时的STEMI患者以1：1：1的比例随机分为3组：1组为直接经皮冠状动脉介入治疗（PCI）联合远程缺血预处理（RIC）和后处理，2组为直接PCI联合后处理，3组为单纯常规PCI（对照组）。在中位随访3.6年的长期随访中，评估了主要不良心脏事件，包括心源性死亡、再梗死和新发充血性心力衰竭。主要发现是，与单纯PCI相比，在直接PCI基础上联合RIC和后处理显著降低了主要不良心脏事件的发生率。主要不良心脏事件的差异主要是由于与仅接受传统PCI的组相比，在接受RIC和后处理联合直接PCI的组中新发充血性心力衰竭事件的发生率显著降低。这是一个重要的发现，增加了越来越多的兴趣，在心力衰竭的治疗作用，远程缺血条件。此外，作者观察到，所有新的充血性心力衰竭事件发生在患者的左心室射血分数（LVEF）降低。虽然可以想象，远程缺血预处理可能通过减少梗死面积和改善心功能间接预防STEMI患者新发充血性心力衰竭，但是，在LIPSIA试验中，直接PCI后各组的估计LVEF无差异，表明其他因素
I read the article written by Stiermaier et al1 with great interest. Stiermaier et al performed long-term, clinical follow-up, post hoc analysis of a prospective, randomized, open-label, controlled LIPSIA CONDITIONING trial of combined intrahospital remote ischaemic perconditioning and postconditioning in ST-elevation myocardial infarction (STEMI). 2 The study randomized 696 patients with STEMI in Germany with symptoms< 12 hours in 1: 1: 1 to either combined remote ischemic perconditioning (RIC) and postconditioning in addition to primary percutaneous coronary intervention (PCI), postconditioning alone in addition to primary PCI, or conventional primary PCI alone (control). Major adverse cardiac events consisting of cardiac death, reinfarction, and new congestive heart failure were assessed during long-term median follow-up of 3.6 years. The main finding was that combined RIC and postconditioning in addition to primary PCI, compared with PCI alone, significantly reduced the incidence of major adverse cardiac event. The difference in major adverse cardiac event was primarily driven by significantly lower incidence of new congestive heart failure events in the group that received combined RIC and postconditioning in addition to primary PCI, compared with the group that received conventional PCI alone. This is an important finding that adds to the growing interest in the therapeutic role of remote ischemic conditioning in heart failure.Furthermore, the authors observed that all the new congestive heart failure events occurred in patients with reduced left ventricular ejection fraction (LVEF). While it is conceivable that remote ischemic conditioning may indirectly prevent new congestive heart failure among the patients with STEMI by reducing infarct size and improving cardiac function, however, in the LIPSIA trial, estimated LVEF was not different among the groups after primary PCI, suggesting that other factors