Remote ischemic preconditioning in percutaneous coronary revascularization: a double-blind randomized controlled clinical trial

Abstract

Objective: To assess the impact of pre-procedural remote ischemic preconditioning on the incidence of myocardial complications following percutaneous coronary intervention. Background: Ischemic preconditioning of a remote vascular territory improves the subsequent ischemic tolerance of distant organs. Method: The Myocardial Event Reduction with Ischemic Preconditioning Therapy (MERIT) trial recruited 80 consecutive patients undergoing elective angioplasty with drug-eluting stents to receive two 5-min lower limb tourniquet occlusions or an un-inflated tourniquet (controls) 1 h before the procedure. The primary outcome was troponin T level at 24 h. Secondary outcomes were intra-procedural chest pain and ST-segment deviation. Results: 6 patients in the control group and 2 in the ischemic preconditioning group had pre-procedural raised troponin T ( p = 0.23). This increased to 16 (40%) in the control group and 5 (12.5%) in the study group at 24 h ( p = 0.01). Fewer patients in the study group experienced intra-procedural chest pain (1 vs. 7, p = 0.056). Mean ST-segment deviation time was 13 ± 35 s in the study group and 58 ± 118 s in the control group ( p = 0.02). At a mean follow-up of 11 months, the major adverse cardiac event rate did not differ significantly between the groups. Conclusion: These data suggest that ischemic preconditioning reduces the absolute risk of post-procedure cardiomyocyte necrosis by 27.5%, and reduces intra-procedural chest pain and ST-segment deviation in patients undergoing percutaneous coronary interventions. We suggest its routine use in percutaneous coronary intervention, although the long-term prognostic impact in this patient group warrants further investigation.