Department of Interventional Cardiology, Papworth Hospital, Cambridge, United Kingdom.
Circ Cardiovasc Interv. 2013 Jun;6(3):246-51. doi: 10.1161/CIRCINTERVENTIONS.112.000184. Epub 2013 May 21.
Postprocedural myocardial infarction (type 4a) has been shown to be an adverse prognostic indicator after elective percutaneous coronary intervention (PCI). The Cardiac Remote Ischemic Preconditioning in Coronary Stenting (CRISP Stent) study demonstrated that remote ischemic preconditioning reduced procedural symptoms, ECG ST-segment deviation, and cardiac troponin I release after elective PCI and reduced the major adverse cardiac and cerebral event (MACCE) rate at 6 months. We were interested to confirm if this early benefit in MACCE rate in the remote ischemic preconditioning group was sustained long-term.
Patients were telephoned by researchers blinded to the randomization details. MACCE, defined as all-cause mortality, nonfatal myocardial infarction, transient ischemic attack or stroke, and heart failure requiring hospital admission, were adjudicated by case note and national database review. One hundred ninety-two (89.3%) of the 225 patients with elective PCI randomized in the original study were available for long-term follow-up (mean time to event or last follow-up: 1579.7±603.6 days). There were a total of 59 (30.7%) MACCEs. Patients with an MACCE had a higher mean cardiac troponin I after PCI (±SD): 2.07±6.99 versus 0.91±2.07 ng/mL (P=0.05). The MACCE rate at 6 years remained lower in the remote ischemic preconditioning group (hazard ratio, 0.58; 95% confidence interval, 0.35-0.97; P=0.039; absolute risk reduction=0.13 and number needed to treat=8 to prevent the MACCE at 6 years).
Remote ischemic preconditioning reduces the incidence of postprocedural cardiac troponin I after elective PCI and confers an MACCE-free survival benefit at both short- and long-term follow-up.
URL: http://www.ukcrn.org.uk. Unique identifier: UKCRN 4074.
择期经皮冠状动脉介入治疗（PCI）后发生的心肌梗死（4a 型）已被证明是预后不良的指标。心脏远程缺血预处理在冠状动脉支架置入术（CRISP 支架）研究中表明，远程缺血预处理可减少择期 PCI 后的手术症状、心电图 ST 段偏移和心肌肌钙蛋白 I 释放，并降低 6 个月时的主要不良心脏和脑事件（MACCE）发生率。我们感兴趣的是确认远程缺血预处理组的 MACCE 发生率早期获益是否长期持续。
研究人员对随机分组细节不知情的情况下通过电话联系患者。MACCE 定义为全因死亡率、非致死性心肌梗死、短暂性脑缺血发作或卒中和需要住院治疗的心衰，通过病例记录和国家数据库审查进行裁定。原始研究中随机接受择期 PCI 的 225 例患者中，有 192 例（89.3%）可进行长期随访（事件或最后随访的平均时间：1579.7±603.6 天）。共有 59 例（30.7%）发生 MACCE。发生 MACCE 的患者 PCI 后心肌肌钙蛋白 I 平均值更高（±SD）：2.07±6.99 与 0.91±2.07ng/mL（P=0.05）。远程缺血预处理组 6 年时的 MACCE 发生率仍较低（风险比，0.58；95%置信区间，0.35-0.97；P=0.039；绝对风险降低=0.13，预防 MACCE 的治疗人数为 8）。
远程缺血预处理可降低择期 PCI 后心肌肌钙蛋白 I 的发生率，并在短期和长期随访中均提供 MACCE 无事件生存获益。
网址：http://www.ukcrn.org.uk。唯一标识符：UKCRN 4074。
