Renoprotective effect of remote ischemic postconditioning in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

Bangming Cao, Chi Zhang, Haipeng Wang, Ming Xia, Xiangjun Yang, Bangming Cao, Chi Zhang, Haipeng Wang, Ming Xia, Xiangjun Yang

Abstract

Background: Whether upper arm remote ischemic postconditioning (RIPostC) exerts protection to kidney in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) remains unknown.

Methods: Sixty-four patients with STEMI were randomized to PPCI + RIPostC (n=29) and PPCI (n=35) groups. RIPostC consisting of 4 cycles of 5 minutes occlusion/reperfusion by cuff inflation/deflation of the upper arm was started within 1 minute after the first balloon dilatation. Peripheral venous blood samples were collected before PPCI and at 0.5, 8, 24, 48, and 72 hours after PPCI to detect serum creatinine (SCr) and creatine kinase-MB (CK-MB). Acute kidney injury (AKI) rate and estimated glomerular filtration rate (eGFR) were calculated. The transthoracic echocardiography was performed 7 days after PPCI to assess left ventricular ejection fraction (LVEF).

Results: The patients in the PPCI + RIPostC group had a lower AKI rate compared with those in the PPCI group (P=0.04). The eGFR after PPCI increased in the PPCI + RIPostC group compared to the PPCI group (P<0.01). The peak of CK-MB concentration in the PPCI + RIPostC group was significantly lower than that in the PPCI group (P<0.01). The area under the curve of CK-MB decreased in the PPCI + RIPostC group compared with that in the PPCI group. LVEF in the PPCI + RIPostC group was significantly higher than that in the PPCI group (P=0.04).

Conclusion: Upper arm RIPostC exerts renal and cardiac protection following cardiac ischemia-reperfusion in patients with STEMI.

Keywords: ST-segmental elevation myocardial infarction; myocardial ischemia reperfusion; primary percutaneous coronary intervention; remote ischemic postconditioning.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Patient flow chart. Abbreviations: eGFR, estimated glomerular filtration rate; PPCI, primary percutaneous coronary intervention; RIPostC, remote ischemic postconditioning; STEMI, ST-elevation myocardial infarction.
Figure 2
Figure 2
Creatine kinase-MB (CK-MB) levels. Notes: The curve of CK-MB levels at each time point (A). The AUC of CK-MB (B). Abbreviations: AUC, area under the curve; CK-MB, creatine kinase-MB; PPCI, primary percutaneous coronary intervention; RIPostC, remote ischemic postconditioning.

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Source: PubMed

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