Remote Ischemic Conditioning Reduces Myocardial Infarct Size and Edema in Patients With ST-Segment Elevation Myocardial Infarction
Abstract Objectives This study aimed to determine whether remote ischemic conditioning (RIC) initiated prior to primary percutaneous coronary intervention (PPCI) could reduce myocardial infarct (MI) size in patients presenting with ST-segment elevation myocardial infarction. Background RIC, using tr...
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| creator | White, Steven K., MD Frohlich, Georg M., MD Sado, Daniel M., MD Maestrini, Viviana, MD Fontana, Marianna, MD Treibel, Thomas A., MBBS Tehrani, Shana, MD Flett, Andrew S., MD Meier, Pascal, MD Ariti, Cono, MSc Davies, John R., PhD Moon, James C., MD Yellon, Derek M., DSc, PhD Hausenloy, Derek J., MD, PhD |
| description | Abstract Objectives This study aimed to determine whether remote ischemic conditioning (RIC) initiated prior to primary percutaneous coronary intervention (PPCI) could reduce myocardial infarct (MI) size in patients presenting with ST-segment elevation myocardial infarction. Background RIC, using transient limb ischemia and reperfusion, can protect the heart against acute ischemia-reperfusion injury. Whether RIC can reduce MI size, assessed by cardiac magnetic resonance (CMR), is unknown. Methods We randomly assigned 197 ST-segment elevation myocardial infarction patients with TIMI (Thrombolysis In Myocardial Infarction) flow grade 0 to receive RIC (four 5-min cycles of upper arm cuff inflation/deflation) or control (uninflated cuff placed on upper arm for 40 min) protocols prior to PPCI. The primary study endpoint was MI size, measured by CMR in 83 subjects on days 3 to 6 after admission. Results RIC reduced MI size by 27%, when compared with the MI size of control subjects (18.0 ± 10% [n = 40] vs. 24.5 ± 12.0% [n = 43]; p = 0.009). At 24 h, high-sensitivity troponin T was lower with RIC (2,296 ± 263 ng/l [n = 89] vs. 2,736 ± 325 ng/l [n = 84]; p = 0.037). RIC also reduced the extent of myocardial edema measured by T2 -mapping CMR (28.5 ± 9.0% vs. 35.1 ± 10.0%; p = 0.003) and lowered mean T2 values (68.7 ± 5.8 ms vs. 73.1 ± 6.1 ms; p = 0.001), precluding the use of CMR edema imaging to correctly estimate the area at risk. Using CMR-independent coronary angiography jeopardy scores to estimate the area at risk, RIC, when compared with the control protocol, was found to significantly improve the myocardial salvage index (0.42 ± 0.29 vs. 0.28 ± 0.29; p = 0.03). Conclusions This randomized study demonstrated that in ST-segment elevation myocardial infarction patients treated by PPCI, RIC, initiated prior to PPCI, reduced MI size, increased myocardial salvage, and reduced myocardial edema. |
| doi_str_mv | 10.1016/j.jcin.2014.05.015 |
| format | Article |
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Background RIC, using transient limb ischemia and reperfusion, can protect the heart against acute ischemia-reperfusion injury. Whether RIC can reduce MI size, assessed by cardiac magnetic resonance (CMR), is unknown. Methods We randomly assigned 197 ST-segment elevation myocardial infarction patients with TIMI (Thrombolysis In Myocardial Infarction) flow grade 0 to receive RIC (four 5-min cycles of upper arm cuff inflation/deflation) or control (uninflated cuff placed on upper arm for 40 min) protocols prior to PPCI. The primary study endpoint was MI size, measured by CMR in 83 subjects on days 3 to 6 after admission. Results RIC reduced MI size by 27%, when compared with the MI size of control subjects (18.0 ± 10% [n = 40] vs. 24.5 ± 12.0% [n = 43]; p = 0.009). At 24 h, high-sensitivity troponin T was lower with RIC (2,296 ± 263 ng/l [n = 89] vs. 2,736 ± 325 ng/l [n = 84]; p = 0.037). RIC also reduced the extent of myocardial edema measured by T2 -mapping CMR (28.5 ± 9.0% vs. 35.1 ± 10.0%; p = 0.003) and lowered mean T2 values (68.7 ± 5.8 ms vs. 73.1 ± 6.1 ms; p = 0.001), precluding the use of CMR edema imaging to correctly estimate the area at risk. Using CMR-independent coronary angiography jeopardy scores to estimate the area at risk, RIC, when compared with the control protocol, was found to significantly improve the myocardial salvage index (0.42 ± 0.29 vs. 0.28 ± 0.29; p = 0.03). Conclusions This randomized study demonstrated that in ST-segment elevation myocardial infarction patients treated by PPCI, RIC, initiated prior to PPCI, reduced MI size, increased myocardial salvage, and reduced myocardial edema.</description><identifier>ISSN: 1936-8798</identifier><identifier>EISSN: 1876-7605</identifier><identifier>DOI: 10.1016/j.jcin.2014.05.015</identifier><identifier>PMID: 25240548</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>acute myocardial infarction ; Aged ; Biomarkers - blood ; Cardiovascular ; cardiovascular magnetic resonance ; Coronary Angiography ; Edema, Cardiac - blood ; Edema, Cardiac - diagnosis ; Edema, Cardiac - etiology ; Edema, Cardiac - prevention & control ; England ; Female ; Humans ; Ischemic Preconditioning, Myocardial - adverse effects ; Ischemic Preconditioning, Myocardial - methods ; Magnetic Resonance Imaging ; Male ; Middle Aged ; myocardial edema ; Myocardial Infarction - blood ; Myocardial Infarction - diagnosis ; Myocardial Infarction - therapy ; Myocardium - pathology ; Percutaneous Coronary Intervention - adverse effects ; Predictive Value of Tests ; primary percutaneous coronary intervention ; remote ischemic conditioning ; reperfusion injury ; Time Factors ; Treatment Outcome ; Troponin T - blood ; Upper Extremity - blood supply</subject><ispartof>JACC. Cardiovascular interventions, 2015, Vol.8 (1), p.178-188</ispartof><rights>American College of Cardiology Foundation</rights><rights>2015 American College of Cardiology Foundation</rights><rights>Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-a26f587e12b75203ef6ad4bea03efbc63de764bd0dbfa9690bc28aea634beaba3</citedby><cites>FETCH-LOGICAL-c411t-a26f587e12b75203ef6ad4bea03efbc63de764bd0dbfa9690bc28aea634beaba3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1936879814010735$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,4010,27900,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25240548$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>White, Steven K., MD</creatorcontrib><creatorcontrib>Frohlich, Georg M., MD</creatorcontrib><creatorcontrib>Sado, Daniel M., MD</creatorcontrib><creatorcontrib>Maestrini, Viviana, MD</creatorcontrib><creatorcontrib>Fontana, Marianna, MD</creatorcontrib><creatorcontrib>Treibel, Thomas A., MBBS</creatorcontrib><creatorcontrib>Tehrani, Shana, MD</creatorcontrib><creatorcontrib>Flett, Andrew S., MD</creatorcontrib><creatorcontrib>Meier, Pascal, MD</creatorcontrib><creatorcontrib>Ariti, Cono, MSc</creatorcontrib><creatorcontrib>Davies, John R., PhD</creatorcontrib><creatorcontrib>Moon, James C., MD</creatorcontrib><creatorcontrib>Yellon, Derek M., DSc, PhD</creatorcontrib><creatorcontrib>Hausenloy, Derek J., MD, PhD</creatorcontrib><title>Remote Ischemic Conditioning Reduces Myocardial Infarct Size and Edema in Patients With ST-Segment Elevation Myocardial Infarction</title><title>JACC. Cardiovascular interventions</title><addtitle>JACC Cardiovasc Interv</addtitle><description>Abstract Objectives This study aimed to determine whether remote ischemic conditioning (RIC) initiated prior to primary percutaneous coronary intervention (PPCI) could reduce myocardial infarct (MI) size in patients presenting with ST-segment elevation myocardial infarction. Background RIC, using transient limb ischemia and reperfusion, can protect the heart against acute ischemia-reperfusion injury. Whether RIC can reduce MI size, assessed by cardiac magnetic resonance (CMR), is unknown. Methods We randomly assigned 197 ST-segment elevation myocardial infarction patients with TIMI (Thrombolysis In Myocardial Infarction) flow grade 0 to receive RIC (four 5-min cycles of upper arm cuff inflation/deflation) or control (uninflated cuff placed on upper arm for 40 min) protocols prior to PPCI. The primary study endpoint was MI size, measured by CMR in 83 subjects on days 3 to 6 after admission. Results RIC reduced MI size by 27%, when compared with the MI size of control subjects (18.0 ± 10% [n = 40] vs. 24.5 ± 12.0% [n = 43]; p = 0.009). At 24 h, high-sensitivity troponin T was lower with RIC (2,296 ± 263 ng/l [n = 89] vs. 2,736 ± 325 ng/l [n = 84]; p = 0.037). RIC also reduced the extent of myocardial edema measured by T2 -mapping CMR (28.5 ± 9.0% vs. 35.1 ± 10.0%; p = 0.003) and lowered mean T2 values (68.7 ± 5.8 ms vs. 73.1 ± 6.1 ms; p = 0.001), precluding the use of CMR edema imaging to correctly estimate the area at risk. Using CMR-independent coronary angiography jeopardy scores to estimate the area at risk, RIC, when compared with the control protocol, was found to significantly improve the myocardial salvage index (0.42 ± 0.29 vs. 0.28 ± 0.29; p = 0.03). Conclusions This randomized study demonstrated that in ST-segment elevation myocardial infarction patients treated by PPCI, RIC, initiated prior to PPCI, reduced MI size, increased myocardial salvage, and reduced myocardial edema.</description><subject>acute myocardial infarction</subject><subject>Aged</subject><subject>Biomarkers - blood</subject><subject>Cardiovascular</subject><subject>cardiovascular magnetic resonance</subject><subject>Coronary Angiography</subject><subject>Edema, Cardiac - blood</subject><subject>Edema, Cardiac - diagnosis</subject><subject>Edema, Cardiac - etiology</subject><subject>Edema, Cardiac - prevention & control</subject><subject>England</subject><subject>Female</subject><subject>Humans</subject><subject>Ischemic Preconditioning, Myocardial - adverse effects</subject><subject>Ischemic Preconditioning, Myocardial - methods</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Middle Aged</subject><subject>myocardial edema</subject><subject>Myocardial Infarction - blood</subject><subject>Myocardial Infarction - diagnosis</subject><subject>Myocardial Infarction - therapy</subject><subject>Myocardium - pathology</subject><subject>Percutaneous Coronary Intervention - adverse effects</subject><subject>Predictive Value of Tests</subject><subject>primary percutaneous coronary intervention</subject><subject>remote ischemic conditioning</subject><subject>reperfusion injury</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Troponin T - blood</subject><subject>Upper Extremity - blood supply</subject><issn>1936-8798</issn><issn>1876-7605</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU2L1TAUhoMozof-AReSpZvWJG3SFkSQy9W5MKLMHXEZ0uR0JrVNxiQduC795abc0YWIqxwO7_tAnoPQC0pKSqh4PZajtq5khNYl4SWh_BE6pW0jikYQ_jjPXSWKtunaE3QW40iIIF3DnqITxllNeN2eop9XMPsEeBf1LcxW4413xibrnXU3-ArMoiHijwevVTBWTXjnBhV0wnv7A7ByBm8NzApbhz-rZMGliL_adIv318Uebua8wNsJ7tWK_Acnb5-hJ4OaIjx_eM_Rl_fb681Fcfnpw27z7rLQNaWpUEwMvG2Asr7hjFQwCGXqHtQ69lpUBhpR94aYflCd6EivWatAiWoN9ao6R6-O3Lvgvy8Qk5xt1DBNyoFfoqQiW2G8q2iOsmNUBx9jgEHeBTurcJCUyNW9HOXqXq7uJeEyu8-llw_8pZ_B_Kn8lp0Db44ByL-8txBk1NmYBmMD6CSNt__nv_2rrifrrFbTNzhAHP0SXPYnqYxMErlfr78en9aEkqbi1S-QC6zm</recordid><startdate>2015</startdate><enddate>2015</enddate><creator>White, Steven K., MD</creator><creator>Frohlich, Georg M., MD</creator><creator>Sado, Daniel M., MD</creator><creator>Maestrini, Viviana, MD</creator><creator>Fontana, Marianna, MD</creator><creator>Treibel, Thomas A., MBBS</creator><creator>Tehrani, Shana, MD</creator><creator>Flett, Andrew S., MD</creator><creator>Meier, Pascal, MD</creator><creator>Ariti, Cono, MSc</creator><creator>Davies, John R., PhD</creator><creator>Moon, James C., MD</creator><creator>Yellon, Derek M., DSc, PhD</creator><creator>Hausenloy, Derek J., MD, PhD</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>2015</creationdate><title>Remote Ischemic Conditioning Reduces Myocardial Infarct Size and Edema in Patients With ST-Segment Elevation Myocardial Infarction</title><author>White, Steven K., MD ; Frohlich, Georg M., MD ; Sado, Daniel M., MD ; Maestrini, Viviana, MD ; Fontana, Marianna, MD ; Treibel, Thomas A., MBBS ; Tehrani, Shana, MD ; Flett, Andrew S., MD ; Meier, Pascal, MD ; Ariti, Cono, MSc ; Davies, John R., PhD ; Moon, James C., MD ; Yellon, Derek M., DSc, PhD ; Hausenloy, Derek J., MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-a26f587e12b75203ef6ad4bea03efbc63de764bd0dbfa9690bc28aea634beaba3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>acute myocardial infarction</topic><topic>Aged</topic><topic>Biomarkers - blood</topic><topic>Cardiovascular</topic><topic>cardiovascular magnetic resonance</topic><topic>Coronary Angiography</topic><topic>Edema, Cardiac - blood</topic><topic>Edema, Cardiac - diagnosis</topic><topic>Edema, Cardiac - etiology</topic><topic>Edema, Cardiac - prevention & control</topic><topic>England</topic><topic>Female</topic><topic>Humans</topic><topic>Ischemic Preconditioning, Myocardial - adverse effects</topic><topic>Ischemic Preconditioning, Myocardial - methods</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Middle Aged</topic><topic>myocardial edema</topic><topic>Myocardial Infarction - blood</topic><topic>Myocardial Infarction - diagnosis</topic><topic>Myocardial Infarction - therapy</topic><topic>Myocardium - pathology</topic><topic>Percutaneous Coronary Intervention - adverse effects</topic><topic>Predictive Value of Tests</topic><topic>primary percutaneous coronary intervention</topic><topic>remote ischemic conditioning</topic><topic>reperfusion injury</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Troponin T - blood</topic><topic>Upper Extremity - blood supply</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>White, Steven K., MD</creatorcontrib><creatorcontrib>Frohlich, Georg M., MD</creatorcontrib><creatorcontrib>Sado, Daniel M., MD</creatorcontrib><creatorcontrib>Maestrini, Viviana, MD</creatorcontrib><creatorcontrib>Fontana, Marianna, MD</creatorcontrib><creatorcontrib>Treibel, Thomas A., MBBS</creatorcontrib><creatorcontrib>Tehrani, Shana, MD</creatorcontrib><creatorcontrib>Flett, Andrew S., MD</creatorcontrib><creatorcontrib>Meier, Pascal, MD</creatorcontrib><creatorcontrib>Ariti, Cono, MSc</creatorcontrib><creatorcontrib>Davies, John R., PhD</creatorcontrib><creatorcontrib>Moon, James C., MD</creatorcontrib><creatorcontrib>Yellon, Derek M., DSc, PhD</creatorcontrib><creatorcontrib>Hausenloy, Derek J., MD, PhD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>JACC. Cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>White, Steven K., MD</au><au>Frohlich, Georg M., MD</au><au>Sado, Daniel M., MD</au><au>Maestrini, Viviana, MD</au><au>Fontana, Marianna, MD</au><au>Treibel, Thomas A., MBBS</au><au>Tehrani, Shana, MD</au><au>Flett, Andrew S., MD</au><au>Meier, Pascal, MD</au><au>Ariti, Cono, MSc</au><au>Davies, John R., PhD</au><au>Moon, James C., MD</au><au>Yellon, Derek M., DSc, PhD</au><au>Hausenloy, Derek J., MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Remote Ischemic Conditioning Reduces Myocardial Infarct Size and Edema in Patients With ST-Segment Elevation Myocardial Infarction</atitle><jtitle>JACC. Cardiovascular interventions</jtitle><addtitle>JACC Cardiovasc Interv</addtitle><date>2015</date><risdate>2015</risdate><volume>8</volume><issue>1</issue><spage>178</spage><epage>188</epage><pages>178-188</pages><issn>1936-8798</issn><eissn>1876-7605</eissn><abstract>Abstract Objectives This study aimed to determine whether remote ischemic conditioning (RIC) initiated prior to primary percutaneous coronary intervention (PPCI) could reduce myocardial infarct (MI) size in patients presenting with ST-segment elevation myocardial infarction. Background RIC, using transient limb ischemia and reperfusion, can protect the heart against acute ischemia-reperfusion injury. Whether RIC can reduce MI size, assessed by cardiac magnetic resonance (CMR), is unknown. Methods We randomly assigned 197 ST-segment elevation myocardial infarction patients with TIMI (Thrombolysis In Myocardial Infarction) flow grade 0 to receive RIC (four 5-min cycles of upper arm cuff inflation/deflation) or control (uninflated cuff placed on upper arm for 40 min) protocols prior to PPCI. The primary study endpoint was MI size, measured by CMR in 83 subjects on days 3 to 6 after admission. Results RIC reduced MI size by 27%, when compared with the MI size of control subjects (18.0 ± 10% [n = 40] vs. 24.5 ± 12.0% [n = 43]; p = 0.009). At 24 h, high-sensitivity troponin T was lower with RIC (2,296 ± 263 ng/l [n = 89] vs. 2,736 ± 325 ng/l [n = 84]; p = 0.037). RIC also reduced the extent of myocardial edema measured by T2 -mapping CMR (28.5 ± 9.0% vs. 35.1 ± 10.0%; p = 0.003) and lowered mean T2 values (68.7 ± 5.8 ms vs. 73.1 ± 6.1 ms; p = 0.001), precluding the use of CMR edema imaging to correctly estimate the area at risk. Using CMR-independent coronary angiography jeopardy scores to estimate the area at risk, RIC, when compared with the control protocol, was found to significantly improve the myocardial salvage index (0.42 ± 0.29 vs. 0.28 ± 0.29; p = 0.03). Conclusions This randomized study demonstrated that in ST-segment elevation myocardial infarction patients treated by PPCI, RIC, initiated prior to PPCI, reduced MI size, increased myocardial salvage, and reduced myocardial edema.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25240548</pmid><doi>10.1016/j.jcin.2014.05.015</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | acute myocardial infarction Aged Biomarkers - blood Cardiovascular cardiovascular magnetic resonance Coronary Angiography Edema, Cardiac - blood Edema, Cardiac - diagnosis Edema, Cardiac - etiology Edema, Cardiac - prevention & control England Female Humans Ischemic Preconditioning, Myocardial - adverse effects Ischemic Preconditioning, Myocardial - methods Magnetic Resonance Imaging Male Middle Aged myocardial edema Myocardial Infarction - blood Myocardial Infarction - diagnosis Myocardial Infarction - therapy Myocardium - pathology Percutaneous Coronary Intervention - adverse effects Predictive Value of Tests primary percutaneous coronary intervention remote ischemic conditioning reperfusion injury Time Factors Treatment Outcome Troponin T - blood Upper Extremity - blood supply |
| title | Remote Ischemic Conditioning Reduces Myocardial Infarct Size and Edema in Patients With ST-Segment Elevation Myocardial Infarction |
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