Abstract 10699: Benefits of Two Different Strategies of Cardioprotection in The Reduction of Periprocedural Miocardial Injury After Programmed Percutaneous Coronary Intervention
Aim: To determine the benefits of two strategies of cardioprotection in the reduction of periprocedural myocardial injury (PMI) after programmed percutaneous coronary intervention (pPCI).
Methods: We conducted a randomized, interventional study: 188 consecutive patients were admitted for a pPCI due to chronic stable angina (CSA). A random distribution was performed: control group (n=84); pretreatment with high-dose statins (PTS) (n=65); or double therapy (DT) of PTS + remote mechanical preconditioning (RMP) (n=66). PTS was defined as the administration of 80 mg of atorvastatin 1 h prior to the pPCI; RMP as three cycles of pressurometry cuff inflation on one arm, 20 mmHg over the patients SBP during 5min. Basal ultrasensitive C-reactive protein (US-CRP) measurements were made. The primary end-point was established as the periprocedural major myocardial injury (PMMI) determined by the levels of Tn in range of type 4A MI according to the 2007 and 2012 definitions.
Results: The basal characteristics had a homogeneous distribution across groups. Both PTS and DT showed a reduction of the primary end-point in regards to the control group using both the 2007 definition (12.8% vs. 10.1% vs. 27.4%; p=0.004) and 2012 definition for MI (6.1% vs. 9.2% vs. 17.9%; p=0.049). No statistical differences across the three groups were found regarding clinical type 4A MI (22.7% vs. 31.2% vs. 28.6%; p=0.83).
In the population chronically treated with statins the two interventions showed the same results with reduction of the primary end-point, with a tendency to the reduction of the primary end-point in the DT over the PTS and the control group (6.9% vs. 11.3% vs. 18.3% respectively; p=0.074). Subgroup analysis by level of US-CRP>2 showed a tendency to a greater benefit of adding RMP to PTS (PTS 4/14, 22.2% vs. DT 0/27, 0%; OR: 0.06, p=0,063).
Conclusions: Both strategies achieve the reduction of MMI in patients with CSA submitted for PCI. No net clinical benefit is reached as rates of MI type 4A are similar between groups. These results are reproduced amongst the patients chronically treated with statins. In those patients with a higher degree of systemic inflammation determined by levels of US-CRP > 2 the addition of the RMP to the PTS (dual therapy) would be beneficial in the reduction of MMI.
- © 2013 by American Heart Association, Inc.