Reinthaler Markus, Jung Friedrich, Empen Klaus
Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany.
Institute of Biomaterial Science and Berlin-Brandenburg Centre for Regenerative Therapies, Helmholtz-Zentrum Geesthacht, Teltow, Germany.
Clin Hemorheol Microcirc. 2018;70(4):381-389. doi: 10.3233/CH-189303.
Remote ischemic preconditioning (RIPC) has been demonstrated to induce potent cardioprotection in individuals experiencing coronary ischemia. A protocol combining limb ischemia and electronic muscle stimulation of the ischemic skeletal muscle (RIPC+), performed in advance of coronary artery occlusion, was superior in terms of infarct size reduction when compared to RIPC alone.
This study was performed to evaluate the benefit of RIPC + in humans compared to a standard RIPC protocol and a control group. Patients with a single vessel coronary artery disease undergoing elective PCI were eligible to participate in this study. ST-segment elevations from an intracoronary ECG during 3 brief episodes of coronary artery balloon occlusions/dilatation were used as the primary endpoint.
ST-elevations significantly declined from the first to the third angioplasty in the control but remained at the same level in the RIPC and RIPC+groups. The RIPC group was characterized by the lowest ST-segment shift during coronary ischemia, which was comparable to coronary balloon occlusion number 3 in the control group, indicating successful preconditioning by the conventional RIPC method. In contrast, ST segment elevations were significantly higher in the RIPC + group. Troponin levels taken 24 h after the study procedure were significantly lower in the RIPC when compared to the control and the RIPC + group.
Our results again confirm the feasibility of remote ischemic preconditioning in patients undergoing coronary angioplasty. According to our results ischemia combined with electronic skeletal muscle stimulation was not superior to conventional RIPC cycles (skeletal muscle ischemia alone).
远程缺血预处理（RIPC）已被证明可在经历冠状动脉缺血的个体中诱导强大的心脏保护作用。与单独的RIPC相比，在冠状动脉闭塞之前进行的肢体缺血与缺血骨骼肌的电子肌肉刺激相结合的方案（RIPC+）在减少梗死面积方面更具优势。
本研究旨在评估与标准RIPC方案和对照组相比，RIPC+对人类的益处。患有单支冠状动脉疾病并接受择期经皮冠状动脉介入治疗（PCI）的患者有资格参与本研究。在3次短暂的冠状动脉球囊闭塞/扩张期间，冠状动脉内心电图的ST段抬高被用作主要终点。
对照组中，ST段抬高从第一次血管成形术到第三次显著下降，但在RIPC组和RIPC+组中保持在同一水平。RIPC组的特点是在冠状动脉缺血期间ST段移位最低，这与对照组的第三次冠状动脉球囊闭塞相当，表明传统RIPC方法成功进行了预处理。相比之下，RIPC+组的ST段抬高明显更高。研究程序后24小时测得的肌钙蛋白水平，RIPC组显著低于对照组和RIPC+组。
我们的结果再次证实了远程缺血预处理在接受冠状动脉血管成形术患者中的可行性。根据我们的结果，缺血与电子骨骼肌刺激相结合并不优于传统的RIPC周期（仅骨骼肌缺血）。
