Author + information
- Received August 5, 2009
- Revision received September 28, 2009
- Accepted October 15, 2009
- Published online January 1, 2010.
- 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† and
- Spyridon Deftereos, MD†
- ↵⁎Reprint requests and correspondence:
Dr. Georgios Giannopoulos, Cardiology Department and Cardiac Catheterization Laboratory, Athens General Hospital, M. Alexandrou 28, 15122 Marousi, Greece
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.
- remote ischemic post-conditioning
- reperfusion injury
- myocardial infarction
- percutaneous coronary intervention
- Received August 5, 2009.
- Revision received September 28, 2009.
- Accepted October 15, 2009.
- American College of Cardiology Foundation