Abstract 16182: Remote Ischemic Preconditioning Improves Outcome Out to 6-years Following Elective Percutaneous Coronary Intervention: the CRISP-Stent Trial
Background: Remote ischemic preconditioning (rIPC) attenuates MI4a in humans undergoing elective percutaneous coronary intervention (PCI). However, the long-term impact of rIPC on clinical outcomes in this setting is unknown. We hypothesized that rIPC attenuation of MI4a would improve clinical outcome at 6-years.
Methods: We randomized 215 patients with normal cardiac troponin-I (cTnI < 0.04ng/mL), undergoing elective PCI to either rIPC (n = 110): three 5-minute blood pressure cuff inflations to 200mmHg around the upper arm with 5-minutes of cuff deflation between, or control (n = 105): a deflated cuff throughout, before PCI. Patients taking nicorandil or glibenclamide were excluded and randomization was stratified for diabetes mellitus (DM). Post-PCI serum cardiac troponin-I (cTnI) levels were recorded at 24-hours and major adverse cardiac and cerebral event (MACCE) rate determined at 6-years (90% follow-up, mean time to event or last follow-up: 1579.7 +/- 603.6 days).
Results: The two groups were matched demographically. Median (IQR) 24-hour cTnI was significantly lower in the rIPC group: 0.06 (0.02-0.56) vs. 0.16 (0.04-1.04)ng/mL, p=0.04. Mean (SD) cTnI was numerically higher in those with MACCE: 0.91 (2.48) vs. 2.07 (6.99) ng/mL, p=0.10. MACCE rate at 6-years was significantly lower in the rIPC group: 23 vs. 36, p=0.039, Figure. The non-DM subgroup (n=166) MACCE rate at 6-years was significantly lower following rIPC (17 vs. 29, p=0.045) but in those with DM (n=49) there was no apparent benefit from rIPC (6 vs. 7, p=0.541).
Conclusion: Fewer patients receiving rIPC have post-PCI cTnI release and rIPC has a superior MACCE-free survival compared to control out to 6-years.
- © 2012 by American Heart Association, Inc.