Interventional cardiology

Preconditioning before primary PCI shows benefit

Remote ischaemic preconditioning, induced by brief periods of limb ischaemia (eg, by inflating a blood-pressure cuff), has previously been shown to reduce ischaemic damage in the heart if applied before predictable ischaemia (eg, cardiac surgery). However, it has not previously been investigated whether remote ischaemic preconditioning can be used to reduce myocardial damage during acute myocardial infarction.

In this randomised trial of 333 patients based in Denmark, 166 patients were randomised to receive primary PCI with remote conditioning, which was applied as intermittent arm ischaemia through four cycles of 5 min inflation and 5 min deflation of a blood-pressure cuff during transportation to hospital. The primary end point was myocardial salvage index at 30 days after PCI, measured by myocardial perfusion imaging.

The median salvage index was 0.75 in the remote conditioning group versus 0.55 in the control group, with a median difference of 0.10 (p=0.033, see figure 1). No difference was seen between rates of death, reinfarction and heart failure in either group.

Conclusions

Remote ischaemic conditioning during ambulance transfer to hospital for primary PCI increases myocardial salvage. However, larger trials are needed to see if this can translate into improved clinical outcomes.

▶ Bøtker HE, Kharbanda R, Schmidt MR, et al Remote ischaemic conditioning before hospital …