Remote Ischemic Postconditioning During Percutaneous Coronary Interventions Remote Ischemic Postconditioning-Percutaneous Coronary Intervention Randomized Trial
Remote Ischemic Postconditioning During Percutaneous Coronary Interventions Remote Ischemic Postconditioning-Percutaneous Coronary Intervention Randomized Trial
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DOI：
10.1161/circinterventions.113.000948
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发表时间：
2014-04-01
影响因子：
5.6
通讯作者：
Lavi, Ronit
中科院分区：
文献类型：
--
作者：
Lavi, Shahar;D'Alfonso, Sabrina;Lavi, Ronit
背景：远程缺血预处理可能导致经皮冠状动脉介入治疗（PCI）期间梗死面积的减少。目前尚不清楚远程缺血后适应（RIPost）是否会降低PCI术后心肌损伤的发生率，以及更大的远端器官（大腿与手臂）的缺血后适应是否会提供进一步的心肌保护。方法和结果：我们将360例基线时出现稳定或不稳定型心绞痛（28%）且肌钙蛋白T呈阴性的患者随机分为3组：2组接受RIPost治疗（上肢或下肢缺血诱导），第三组为对照组。RIPost在支架放置后立即应用于PCI，通过3个5分钟的周期将血压袖带膨胀至臂部或大腿部200毫米汞柱（对照组20毫米汞柱），每个周期之间休息5分钟。主要终点是术后（6小时或18-24小时）肌钙蛋白T水平为bb0 3xULN的患者比例，其中ULN代表正常上限。120例患者随机分为两组。三组患者的基线特征无差异。手臂组、大腿组和对照组的主要结局分别为30%、35%和35% （P=0.64）。两组间PCI术后肌酸激酶或高敏c反应蛋白水平及急性肾损伤发生率均无差异。结论- ripost在PCI术中不能降低术中心肌损伤的发生率。对上肢或下肢进行远端缺血，也可获得类似的效果。
Background-Remote ischemic preconditioning may result in reduction in infarct size during percutaneous coronary intervention (PCI). It is unclear whether remote ischemic postconditioning (RIPost) will reduce the incidence of myocardial injury after PCI, and whether ischemic conditioning of a larger remote organ (thigh versus arm) would provide further myocardial protection.Methods and Results-We randomized 360 patients presenting with stable or unstable angina (28% of patients) and negative Troponin T at baseline to 3 groups: 2 groups received RIPost (induced by ischemia to upper or lower limb), and a third was the control group. RIPost was applied during PCI immediately after stent deployment, by three 5-minute cycles of blood pressure cuff inflation to >200 mm Hg in the arm or thigh (20 mm Hg in the control) with 5-minute breaks between each cycle. The primary end-point was the proportion of patients with Troponin T levels >3xULN postprocedure (at 6 or 18-24 hours), where ULN stands for upper limit of normal. A total of 120 patients were randomized to each group. There were no differences in baseline characteristics between the 3 groups. The primary outcome occurred in 30%, 35%, and 35% of the arm, thigh, and control groups, respectively (P=0.64). There were no differences in creatine kinase or high sensitivity C-reactive protein levels after PCI or in the incidence of acute kidney injury between the groups.Conclusions-RIPost during PCI did not reduce the incidence of periprocedural myocardial injury. Similar effect was obtained when remote ischemia was induced to the upper or lower limb.