Protective role of single versus multiple remote ischemic preconditioning in elective percutaneous coronary interventions.

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Cardiology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

Abstract

Background: One common approach to treat the symptoms of coronary artery disease (CAD) is percutaneous coronary intervention (PCI). Unfortunately, the myocardium is vulnerable to ischemia reperfusion damage whenever a previously blocked coronary artery is reopened. Aim of the work: Our aim is to compare the efficacy of single and multiple remote ischemic preconditioning (RIPC) in preventing post-percutaneous coronary intervention (PCI) chest discomfort, ST-segment deviation, and myocardial infarction. Subjects and Methods: In this prospective interventional trial, 125 patients were included who had been diagnosed with CAD and were candidates for PCI. Four groups of patients were studied separately. Fifty individuals made up Group I; they were all treated with repeated cycles of RIPC for both their upper and lower extremities. Group II, III and IV comprised 25 patients, each of them received a single cycle of RIPC on upper limb, single cycle of RIPC on lower limb or no RIPC respectively. We assessed cardiac troponin levels before and after PCI as well as major cardiac cerebrovascular events. Results: Compared with the group I, II and III, the group IV displayed significant (more than 3-fold) increase of cardiac troponin I levels 24 hours post PCI (p value = 0.010), coupled with higher incidence of chest pain and transient ST segment elevation during PCI (p < 0.001). Moreover, 5th day and three months later creatinine levels were higher in the group IV (p= 0.001 and 0.002 respectively). Conclusion: Remote ischemic preconditioning has a valuable role in protecting myocardial injury post PCI. Both modes single and multiple RIPC provided similar defense outcomes. We advocate routine application of RIPC before elective PCI.

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