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5 Effect of remote ischaemic preconditioning on coronary artery function in patients with stable coronary artery disease
  1. David S Corcoran1,2,3,
  2. Robin Young,
  3. MD Pio Cialdella1,
  4. Peter McCartney1,2,
  5. Amrit Bajrangee1,
  6. Barry Hennigan1,2,
  7. Damien Collison1,
  8. David Carrick1,
  9. Aadil Shaukat1,
  10. Richard Good1,
  11. Stuart Watkins1,
  12. Margaret McEntegart1,
  13. Jonathan Watt1,
  14. Paul Welsh2,
  15. Naveed Sattar2,
  16. Alex McConnachie3,
  17. Keith G Oldroyd1,
  18. Colin Berry1,2
  1. 1West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow
  2. 2British Heart Foundation (BHF) Glasgow Cardiovascular Research Centre, University of Glasgow
  3. 3Robertson Centre for Biostatistics, University of Glasgow

Abstract

Background Remote ischaemic preconditioning (RIPC) is a cardioprotective intervention invoking intermittent ischaemia in a tissue remote from the heart. Its mechanisms are incompletely understood. We hypothesised that RIPC might enhance coronary vasodilatation by an endothelium-dependent mechanism.

Methods We performed a prospective, randomised, sham-controlled, blinded clinical trial. Patients with stable coronary artery disease undergoing elective angiography were randomised 1:1 to RIPC or sham. Endothelial-dependent and –independent function was assessed with intracoronary (ic) acetylcholine (ACh) and ic nitrate, respectively. Coronary luminal diameter was assessed by QCA. Primary outcome: between-group difference in mean% change in coronary luminal diameter following ACh.

Results Following angiography, 60/75 patients (mean ±SD age 57.5±8.5 years; 80% male) were eligible and completed the protocol (n=30 RIPC, n=30 sham). The mean% change in coronary luminal diameter was −13.3±22.3% and −2.0±17.2% in the sham and RIPC groups respectively (difference 11.32%, 95% CI: 1.2 to 21.4, p=0.032) (figure 1). This remained significant with age and sex as covariates (difference 11.01%, 1.01–21.0, p=0.035).

Abstract 5 Figure 1

Endothelial-dependent and independent function testing results. ACh=acetylcholine, GTN=glyceryl trinitrate

Conclusions RIPC attenuates the extent of vasoconstriction induced by intracoronary acetylcholine infusion, and this endothelium-dependent mechanism may contribute to its cardioprotective effects.

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