CBS 2019
CBSMD教育中心
中 文

Acute Coronary Syndrom

Abstract

Recommended Article

Homeostatic Chemokines and Prognosis in Patients With Acute Coronary Syndromes Impact of Percutaneous Coronary Intervention for Chronic Total Occlusion in Non-Infarct-Related Arteries in Patients With Acute Myocardial Infarction (from the COREA-AMI Registry) Predicting Major Adverse Events in Patients With Acute Myocardial Infarction Shock Team Approach in Refractory Cardiogenic Shock Requiring Short-Term Mechanical Circulatory Support: A Proof of Concept Comparison in prevalence, predictors, and clinical outcome of VSR versus FWR after acute myocardial infarction: The prospective, multicenter registry MOODY trial-heart rupture analysis SCAI Clinical Expert Consensus Statement on Cardiogenic Shock High-sensitivity troponin in the evaluation of patients with suspected acute coronary syndrome: a stepped-wedge, cluster-randomised controlled trial Intraaortic Balloon Pump in Cardiogenic Shock Complicating Acute Myocardial Infarction: Long-Term 6-Year Outcome of the Randomized IABP-SHOCK II Trial

Original Research2016 Jul 1;102(13):1023-8.

JOURNAL:Heart. Article Link

Remote ischaemic conditioning and healthcare system delay in patients with ST-segment elevation myocardial infarction

Pryds K, Terkelsen CJ, CONDI Investigators. Keywords: STEMI; remote ischaemic conditioning; healthcare system delay

ABSTRACT


OBJECTIVE - We investigated influence of remote ischaemic conditioning (RIC) on the detrimental effect of healthcare system delay on myocardial salvage in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI).


METHODS - A post-hoc analysis of a randomised controlled trial in patients with STEMI randomised to treatment with pPCI or RIC+pPCI. RIC was performed as four cycles of intermittent 5 min upper arm ischaemia and reperfusion. Healthcare system delay was defined as time from emergency medical service call to pPCI-wire. Myocardial salvage index (MSI) was assessed by single photon emission computerised tomography.


RESULTS - Data for healthcare system delay and MSI were available for 129 patients. MSI was negatively associated with healthcare system delay in patients treated with pPCI alone (-0.003 decrease in MSI/min of healthcare system delay; 95% CI -0.005 to -0.001, r(2)=0.11, p=0.008) but not in patients treated with RIC+pPCI (-0.0002 decrease in MSI/min of healthcare system delay; 95% CI -0.001 to 0.001, r(2)=0.002, p=0.74). In patients with healthcare system delay ≤120 min, RIC+pPCI did not affect median MSI compared with pPCI alone (0.75 (IQR: 0.49-0.99) and 0.70 (0.45-0.94), p=1.00). However, in patients with healthcare system delay >120 min, RIC+pPCI increased median MSI compared with pPCI alone (0.74 (0.52-0.93) vs 0.42 (0.22-0.68), p=0.02). Adjusting for potential confounders did not affect the results.


CONCLUSIONS - RIC as adjunctive to pPCI attenuated the detrimental effect of healthcare system delay on myocardial salvage in patients with STEMI, suggesting that the cardioprotective effect of RIC increases with the duration of ischaemia.



TRIAL REGISTRATION NUMBER - NCT00435266; post-results.