Effects Of Remote Ischemic Preconditioning On Perioperative Clinical Events In Patients Undergoing Elective Percutaneous Coronary Intervention

ObjectiveWith the increase of ACS events,It has also increased markedly in clinical thrombolytic therapy and percutaneous coronary intervention.Myocardial Ischemia reperfusion injury(IRI)is common in clinical causes,which could affect distant non-ischemic organs with greatest harm including the heart may cause arrhythmia?myocardial stunning and cardiac insufficiency.When patients with AMI underging revascularization,they may experience hypotension with MRI,or even no-reflow phenomenon.The incidence of reinfarction mortality?malignant arrhythmia,and heart failure increased significantly after PCI surgery.Major cardiac events(MACE)had a high incidence during the perioperative period.Therefore,how to reduce the reperfusion injury and maximum protection of ischemic myocardium has attracted more and more attention.Remote ischemic postconditioning(RIPC)is a non-pharmacological and noninvasive treatment widely used in biology and clinic for more than 30 years.IPC is a widespread biological phenomenon,which found that ischemic preconditioning can effectively reduce myocardial damage during sustained ischemia and reperfusion and play a protective role against the IRI.Animal experiments and clinical studies have confirmed that RIPC is an effective cardioprotective method.At the same time,it also applies to the protection and treatment of important organs such as kidneys and brains,exploring whether it is applicable to coronary heart diseases primary and secondary prevention.It has become a research hotspot in animal experiments for many years.However,due to the complexity of its mechanisms and the contradictory conclusions of experiments with small sample sizes,clinical transformation has not been able to further advance.It is more expected that RIPC will have clinical benefit during the perioperative period.The research with the goal:1.using perioperative-related cardiac damage and cardiac function parameters to evaluate the protective effect of RIPC;2.To investigate the effect of acute hemodynamics of coronary collateral flow which explore the cardiac protection mechanism of RIPC;3.Long-term prognosis of patients to evaluate the long-term benefit of ischemic preconditioning for patients with coronary heart disease;3.In this study,we analyzed long-term follow-up data,which investigate the effects of RIPC on in-hospital clinical outcome in adult patients undergoing cardiac surgery.Methods:A total of 34patients with coronary heart disease of one-vessel severe(70%-85%)stenosis confirmed by angiography were enrolled into this study.They were randomly divided into the RIPC group(18 patients)and the control group(16patients).And,for these patients,distal pressure of coronary artery stenosis before balloon dilation(non-occlusive pressure,P_n-occl)and distal coronary artery occlusive pressure(P_occl)during balloon dilation occlusion were measured in all patients.The patients in the RIPC group induced by three cycles of lower limb ischemia-reperfusion preconditioning(5 minutes inflations of a blood pressure cuff,followed by 5 minutes reperfusion).For controls,the cuff was not inflated.After this processing,P_n-occland P_occlwere measured again in each patient.Review of cardiac echocardiogram and creatinine?e GFR?and c TNI at 2 h,12 h,1-7 days,and 30 days after PCI for a subset of patients followed for more than six months.ResultsThere were no significant differences in angiographic characteristics between two groups(All P>0.05).The troponin I(TNI)levels after percutaneous coronary intervention(PCI)were lower in the RIPC groups than those in controls(P=0.004).For the RIPC group,mean P_n-occ,and P_occlsignificantly increased after RIPC,compared to those before RIPC([72.78±10.10]mm Hg vs.[79.67±9.79]mm Hg,P=0.002,[20.89±8.61]mm Hg vs.[26.78±10.73]mm Hg,P=0.001,respectively).Conclusions:1.RIPC can improve cardiac function(LVEF)in patients undergoing PCI and protect against myocardial damage caused by PCI.2.RIPC can improve coronary perfusion pressure and rapidly increase distal coronary occlusion pressure,thereby improving coronary collateral blood flow;distal coronary perfusion pressure and coronary collateral flow in RIPC applied in human studies proved to be Effective.3.RIPC can reduce the occurrence of perioperative complex cardiovascular events.