| Objective: To explore the protective effect of remote ischemic preconditioning(RIPC)on the myocardial protection of patients with unstable angina pectoris with normal baseline troponin before elective percutaneous coronary intervention(PCI).Method: A total of 104 patients with unstable angina pectoris who were admitted to the Department of Cardiology of the Second Affiliated Hospital of Dalian Medical University from February 2019 to November 2019 and underwent elective PCI were selected.Subjects were randomized to 2 groups: The RIPC group(n=49),whose members received RIPC(created by three 5-minute inflations of a pneumatic medical tourniquet cuff to 200 mm Hg around the upper arm,interspersed with 5-minute intervals of reperfusion)at 2 hours before the PCI procedure,and the control group(n = 55).Patients in the control group also placed cuffs,but did not undergo remote ischemic preconditioning.Serum hs-c Tn I and CK-MB levels were measured at 12 hours and 24 hours after PCI by the Department of Laboratory Medicine of the Second Affiliated Hospital of Dalian Medical University.The patient completed at least one ECG examination within 48 hours after PCI.The major adverse cardiac events were recorded at 3months after PCI including myocardial infarction,revascularization,heart failure and death for coronary heart disease.At the same time,whether the occurrence of type 4a myocardial infarction(type 4a MI)occurred according to the level of hs-c Tn I at 12 hours and 24 hours after PCI and the typical electrocardiogram changes within 48 hours after PCI was divided into type 4a MI group and non-4a MI group.Based on the observation and comparison of the preoperative general data,previous medical history,blood biochemical indicators,characteristics of coronary angiography target vessels,and operating parameters during PCI,the two groups of patients were analyzed by Logistic regression to analyze the key risk factors of PCI-related myocardial infarction.All data were statistically analyzed using SPSS22.0 statistical software.Results:1.The baseline demographic and clinical characteristics,including age,sex,heart rate,systolic blood pressure,BMI,rate of smoking,medical history,risk stratification of GRACE score,laboratory values,medication,features of coronary angiographic lesions,dosage of contrast medium,and number of stents implantation were similar between the control group and the RIPC group(P>0.05).2.There was no significant difference in baseline hs-c Tn I levels between the control group and the RIPC group before PCI(P> 0.05).The primary outcomes were hs-c Tn I levels and incidence of myocardial infarction(MI 4a,)at 12 hours and 24 hours after the PCI procedure.The median hs-c Tn I levels were lower in the RIPC group than those in the control group at 12 hours and 24 hours after PCI,although there was no significant statistical difference(P> 0.05).The incidence of MI 4a was lower in the RIPC(25% VS43.6%,P <0.05).3.The rate of MACE was not significant difference between the control group and the RIPC group at 3months after PCI(P> 0.05).4.Logistic regression analysis showed that the target blood vessel type C lesion was a risk factor for type 4a myocardial infarction,(P <0.05);preoperative RIPC treatment was a protective factor for type 4a myocardial infarction to a certain extent,P = 0.05.5.There were no obvious adverse reactions during the hospitalization and within 3 months after PCI when the patients accepted the remote ischemic preconditioning.Conclusion:1.Myocardial injury or even type 4a myocardial infarction occurred in some patients undergoing elective PCI;RIPC reduced the incidence of type 4a MI after PCI.2.The use of RIPC for patients with unstable angina pectoris with normal baseline troponin before elective PCI is clinically safe and operable.3.Targeted C-type lesions in patients with unstable angina pectoris undergoing elective PCI are a risk factor for type 4a myocardial infarction. |
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