Author + information
- Received December 31, 2013
- Revision received May 19, 2014
- Accepted May 27, 2014
- Published online January 1, 2015.
- Steven K. White, MD∗,†,
- Georg M. Frohlich, MD†,
- Daniel M. Sado, MD†,
- Viviana Maestrini, MD†,
- Marianna Fontana, MD†,
- Thomas A. Treibel, MBBS†,
- Shana Tehrani, MD†,
- Andrew S. Flett, MD‡,
- Pascal Meier, MD†,
- Cono Ariti, MSc§,
- John R. Davies, PhD‖,
- James C. Moon, MD†,
- Derek M. Yellon, DSc, PhD∗ and
- Derek J. Hausenloy, MD, PhD∗,†∗ ()
- ∗The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, National Institute of Health Research University College London Hospitals Biomedical Research Centre, University College London, London, United Kingdom
- †The Heart Hospital, London, United Kingdom
- ‡Department of Cardiology, University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
- §London School of Hygiene and Tropical Medicine, London, United Kingdom
- ‖The Essex Cardiothoracic Centre, Basildon University Hospital, Nethermayne, Basildon, Essex, United Kingdom
- ↵∗Reprint requests and correspondence:
Dr. Derek J. Hausenloy, The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, NIHR University College London Hospitals Biomedical Research Centre, University College London Hospital and Medical School, 67 Chenies Mews, London WC1E 6HX, United Kingdom.
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.
- acute myocardial infarction
- cardiovascular magnetic resonance
- myocardial edema
- primary percutaneous coronary intervention
- remote ischemic conditioning
- reperfusion injury
This work was supported by grants from the British Heart Foundation (RG/03/007, FS/10/039/28270, and FS/10/72/28568), the Rosetrees Trust, and the National Institute for Health Research University College London Hospitals Biomedical Research Centre. Dr. Frohlich has received a research grant from the Swiss National Foundation. Dr. Davies has received honoraria for attending meetings from Boston Scientific; and has received speaking fees from AstraZeneca and Pfizer Inc.. Dr. Yellon serves on the advisory board to AstraZeneca; and has received research support from Merck Sharp & Dohme. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 31, 2013.
- Revision received May 19, 2014.
- Accepted May 27, 2014.
- 2015 American College of Cardiology Foundation