Coronary Artery Disease Clinical Trial
Official title:
Remote Ischemic Preconditioning in ad Hoc Percutaneous Coronary Interventions: a Randomized Clinical Study
Elective percutaneous coronary intervention (PCI) is associated with troponin release in approximately one third of cases. Myocardial necrosis may result from downstream embolization of atheromatous material, coronary side-branch occlusion and may involve ischemia/reperfusion injury. The investigators hypothesized that a single remote ischemic preconditioning cycle would reduce peri-procedural troponin release.
Elective percutaneous coronary intervention (PCI) is associated with troponin release in
approximately one third of cases, which is a sensitive and specific marker of myocyte
necrosis. Myocardial necrosis may result from downstream embolization of atheromatous
material, coronary side-branch occlusion and may involve ischemia/reperfusion injury. A
number of studies have demonstrated that procedure-related troponin release is associated
with subsequent cardiovascular events and a worst prognosis, especially in those patients
with the most marked elevation in troponin concentration.
Recently, 3 cycles of 5-minute ischemia followed by 5-minute reperfusion of the upper
extremities were shown to reduce troponin release in elective PCI. However, this ischemic
preconditioning (IPC) protocol requires 30 minutes and is of limited use in the context of
PCI at the time of initial cardiac catheterization (ad hoc coronary intervention).
Since experimental evidence suggests that IPC is a graded than an "all-or-nothing"
phenomenon, and even a short, single IPC cycle may have protective effects in the
myocardium, the investigators hypothesized that patients undergoing ad hoc coronary
intervention would have reduced peri-procedural troponin release if subjected to a single,
remote IPC cycle, between diagnostic catheterization and coronary intervention.
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Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Treatment
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