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Remote Ischemic Preconditioning Stimulus Does Not Reduce Microvascular Resistance or Improve Myocardial Blood Flow in Patients Undergoing Elective Percutaneous Coronary Intervention

Department of Cardiovascular Medicine, Addenbrooke's Hospital, Hills Rd, Cambridge CB2 0QQ, United Kingdom, Department of Cardiology, Papworth Hospital, Papworth Everard, Cambridge CB23 3RE, United Kingdom

Patrick M. Heck, MA, MRCP

Department of Medical Physics and Clinical Engineering, Addenbrooke's Hospital, Hills Rd, Cambridge CB2 0QQ, United Kingdom, Department of Cardiology, Papworth Hospital, Papworth Everard, Cambridge CB23 3RE, United Kingdom, Department of Cardiovascular Medicine, Addenbrooke's Hospital, Hills Rd, Cambridge CB2 0QQ, United Kingdom

Paul A. White, PhD

Department of Cardiology, Papworth Hospital, Papworth Everard, Cambridge CB23 3RE, United Kingdom

Sadia N. Khan, MA, MRCP

Department of Cardiology, Papworth Hospital, Papworth Everard, Cambridge CB23 3RE, United Kingdom, Department of Cardiovascular Medicine, Addenbrooke's Hospital, Hills Rd, Cambridge CB2 0QQ, United Kingdom

Michael O'Sullivan, MA, PhD, MRCP

Department of Cardiology, Papworth Hospital, Papworth Everard, Cambridge CB23 3RE, United Kingdom, Department of Cardiovascular Medicine, Addenbrooke's Hospital, Hills Rd, Cambridge CB2 0QQ, United Kingdom

Sarah C. Clarke, MD, FRCP

Department of Cardiology, Papworth Hospital, Papworth Everard, Cambridge CB23 3RE, United Kingdom

David P. Dutka, MD, FRCP

Department of Cardiovascular Medicine, Addenbrooke's Hospital, Hills Rd, Cambridge CB2 0QQ, United Kingdom, dpd24{at}cam.ac.uk

Introduction: Remote ischemic preconditioning (RIPC) may limit myocardial infarction by improving microvascular function and maintaining myocardial blood flow. We hypothesized that a RIPC stimulus would reduce coronary microvascular resistance and improve coronary blood flow during elective percutaneous coronary intervention (PCI).

Method: We prospectively recruited 54 patients with multi-vessel disease (MVD = 32) or single vessel disease awaiting elective PCI. Patients with MVD had non-target vessel (NTV) index of micro-circulatory resistance (IMR) determined, before and after target vessel (TV) PCI (cardiac RIPC). The effect of arm RIPC on serial microvascular resistance (R_p) was assessed in patients with single vessel disease.

Results: TV balloon occlusion did not alter the NTV IMR: 16.5 (12.4) baseline vs. 17.6 (11.6) post cardiac RIPC, P = 0.65 or hyperaemic transit time. Arm RIPC did not alter R _p in patients with single vessel disease: Rp, mmHg.cm^-1.s ^-1: 3.5 (1.9) baseline vs. 4.1 (3.0) post arm RIPC, P = 0.19 and coronary flow velocity remained constant. Conclusion: RIPC stimuli during elective PCI do not affect coronary microvascular resistance or coronary flow in humans.

Key Words: microcirculation • elective percutaneous coronary intervention • remote ischemic preconditioning

This version was published on August 1, 2009

Angiology, Vol. 60, No. 4, 403-411 (2009)
DOI: 10.1177/0003319708328921


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