Study of limb remote ischemic pre-adaptation provides cardio protection in patients received noncritical percutaneous coronary intervention

FANG Zhe; ZHANG Qi; ZHANG Bing

doi:10.3969/j.issn.1672-5301.2024.11.013

Abstract：Objective To investigate the myocardial protective effect of limb remote ischemia pre-adaptation(RIPC)on acute coronary syndrome(ACS)patients undergoing elective percutaneous coronary intervention(PCI).Methods A total of 130 patients with ACS who underwent elective PCI in Yanbian University Affiliated Hospital cardiology department from January 2021 to October 2022,and 120 patients were finally enrolled.The eligible patients were randomly divided into upper limb RIPC group(n=30),lower limb RIPC group(n=30),combined upper and lower limb RIPC group(n=30)and control group(n=30),In the combined upper and lower limb remote ischemic preconditioning(RIPC)group,patients had their right upper limb and right lower limb simultaneously bound with a blood pressure cuff and inflated to 200 mmHg for 2 hours before percutaneous coronary intervention(PCI).The remaining treatment was the same as that for the upper limb RIPC group and the lower limb RIPC group.The control group,without this process,underwent PCI directly.The levels of myocardial myoglobin(Myo),cardiac troponin I(cTnI),creatine kinase-MB(CK-MB),and high-sensitivity C-reactive protein(hs-CRP)were compared among the four groups before surgery and 24 hours after surgery.Major adverse cardiovascular events(MACE)during the postoperative hospital stay and within 6 months after discharge were recorded.The impact of limb RIPC on the prognosis of patients after PCI was observed by assessing the incidence of MACE events.Results There were no statistically significant differences in the baseline levels of Myo,cTnI,CK-MB,and hs-CRP among the four groups before surgery(P＞0.05).There were also no statistically significant differences in the postoperative levels of Myo,CK-MB,and hs-CRP among the four groups(P＞0.05).Contrarily,the Postopertive level of cTnI in the RIPC group was significantly lower than that in the control group,There are statistically incidence(P＜0.05).Additionally,there were no statistically significant differences among the four groups in terms of the average diameter,length,number of stents implanted in coronary lesion vessels,and the amount of contrast agent used during the surgery(P＞0.05).During the surgery,patients in the upper limb RIPC group(10％),lower limb RIPC group(6.67％),and combined upper and lower limb RIPC group(6.67％)had a significantly lower incidence of chest pain compared to the control group(20％),with statistical significance(P＜0.05).Regarding the situation during hospitalization and the 6-month follow-up after discharge,the incidence of MACE events in the upper limb RIPC group(7.41％),lower limb RIPC group(8％),and combined upper and lower limb RIPC group(11.1％)was significantly lower than that in the control group(28.57％),with statistical significance(P＜0.05).Conclusion Limb RIPC can reduce the occurrence of elective PCI myocardial injury and intraoperative chest pain in ACS patients,and can improve the prognosis of elective PCI patients 6 months after surgery.