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

• Published in: Angiology 2009-08, Vol.60 (4), p.403-411
• Main Authors: Hoole, Stephen P., Heck, Patrick M., White, Paul A., Khan, Sadia N., O'Sullivan, Michael, Clarke, Sarah C., Dutka, David P.
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty, Balloon, Coronary - adverse effects; Arm - blood supply; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - physiopathology; Coronary Artery Disease - therapy; Coronary Circulation; Coronary heart disease; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Heart; Humans; Ischemic Preconditioning - methods; Male; Medical sciences; Microcirculation; Middle Aged; Myocardial Infarction - etiology; Myocardial Infarction - physiopathology; Myocardial Infarction - prevention & control; Prospective Studies; Radiography; Severity of Illness Index; Tourniquets; Treatment Outcome; Vascular Resistance
• ISSN: 0003-3197; 1940-1574
• DOI: 10.1177/0003319708328921

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 (Rp) 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 Rp 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.