This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rentoukas, I. Articles by Deftereos, S. Search for Related Content PubMed Articles by Rentoukas, I. Articles by Deftereos, S. Related Collections Related Article

Cardioprotective Role of Remote Ischemic Periconditioning in Primary Percutaneous Coronary Intervention

Enhancement by Opioid Action

Ilias Rentoukas, MD^_*, Georgios Giannopoulos, MD^,_*, Andreas Kaoukis, MD, Charalampos Kossyvakis, MD, Konstantinos Raisakis, MD, Metaxia Driva, MD, Vasiliki Panagopoulou, MD, Konstantinos Tsarouchas, MD^_*, Sofia Vavetsi, MD^_*, Vlasios Pyrgakis, MD, Spyridon Deftereos, MD

^_* Cardiology Department, "A. Fleming" General Hospital, Melissia, Greece
Cardiology Department and Cardiac Catheterization Laboratory, Athens General Hospital "G. Gennimatas," Athens, Greece

^_* Reprint requests and correspondence: Dr. Georgios Giannopoulos, Cardiology Department and Cardiac Catheterization Laboratory, Athens General Hospital, M. Alexandrou 28, 15122 Marousi, Greece (Email: ggiann{at}med.uoa.gr).

Objectives: We sought to determine the potential of remote ischemic periconditioning (RIPC), and its combination with morphine, to reduce reperfusion injury in primary percutaneous coronary interventions.

Background: Remote ischemic post-conditioning is implemented by applying cycles of ischemia and reperfusion on a remote organ, which result in release of circulating factors inducing the effects of post-conditioning on the myocardium.

Methods: A total of 96 patients (59 men) were enrolled. The patients were randomized to groups as follows: 33 to each treatment group (Group A: RIPC; Group B: RIPC and morphine) and 30 to the control group (Group C). Measures of efficacy were achievement of full ST-segment resolution (primary), and reduction of ST-segment deviation score and peak troponin I during hospitalization.

Results: A higher proportion of patients in Groups A (73%) and B (82%) achieved full ST-segment resolution after percutaneous coronary intervention, compared with control patients (53%) (p = 0.045). Peak troponin I was lowest in Group B, 103.3 ± 13.3 ng/ml, in comparison to peak levels in Group A, 166.0 ± 28.0 ng/ml, and the control group, 255.5 ± 35.5 ng/ml (p = 0.0006). ST-segment deviation resolution was 87.3 ± 2.7% in Group B, compared with 69.9 ± 5.1% in Group A and 53.2 ± 6.4% in the control group (p = 0.00002). In paired comparisons between groups, Group B did better than the control group in terms of both ST-segment reduction (p = 0.0001) and peak troponin I (p = 0.004), whereas Group A differences from the control group did not achieve statistical significance (p = 0.054 and p = 0.062, respectively).

Conclusions: These findings demonstrate a cardioprotective effect of RIPC and morphine during primary percutaneous coronary intervention for the prevention of reperfusion injury. This is in agreement with observations that the beneficial effect of RIPC is inhibited by the opioid receptor blocker naloxone.

Key Words: remote ischemic post-conditioning • periconditioning • reperfusion injury • myocardial infarction • percutaneous coronary intervention • morphine

Abbreviations and Acronyms   mPTP = mitochondrial permeability transition pores   PCI = percutaneous coronary intervention   RIPC = remote ischemic periconditioning   STEMI = ST-segment elevation myocardial infarction   TnI = troponin I

Related Article

Post-Conditioning for Cardioprotection During Reperfusion Therapy: Too Good to Be True?

Abhiram Prasad
J. Am. Coll. Cardiol. Intv. 2010 3: 56-57. [Full Text] [PDF]

This article has been cited by other articles:

				G. Heusch, P. Kleinbongard, A. Skyschally, B. Levkau, R. Schulz, and R. Erbel The coronary circulation in cardioprotection: more than just one confounder Cardiovasc Res, November 9, 2011; (2011) cvr271v2. [Abstract] [Full Text] [PDF]

				R. Jaffe, A. Dick, and B. H. Strauss Prevention and Treatment of Microvascular Obstruction-Related Myocardial Injury and Coronary No-Reflow Following Percutaneous Coronary Intervention: A Systematic Approach J. Am. Coll. Cardiol. Intv., July 1, 2010; 3(7): 695 - 704. [Abstract] [Full Text] [PDF]

				A. Prasad Post-Conditioning for Cardioprotection During Reperfusion Therapy: Too Good to Be True? J. Am. Coll. Cardiol. Intv., January 1, 2010; 3(1): 56 - 57. [Full Text] [PDF]