PMID- 32598657
OWN - NLM
STAT- MEDLINE
DCOM- 20200917
LR  - 20200917
IS  - 0040-3660 (Print)
IS  - 0040-3660 (Linking)
VI  - 92
IP  - 1
DP  - 2020 Jan 15
TI  - [Impact of endothelial dysfunction on the course of acute ST-elevation myocardial 
      infarction and its correction by remote ischemic preconditioning].
PG  - 10-14
LID - 10.26442/00403660.2020.01.000140 [doi]
AB  - Aim of the study - to assess the effect of remote ischemic preconditioning (RIPC) 
      on the incidence of endothelial dysfunction (ED) and its impact on hospital 
      prognosis in patients with ST segment elevation acute myocardial infarction 
      (STEMI). MATERIALS AND METHODS: We conducted a single - centre, open - label 
      prospective study that included 173 patients with STEMI who underwent primary 
      percutaneous coronary intervention within the first 24 hours of the symptoms 
      onset. Before the PCI, patients were randomized into two groups. In the first 
      group (n=86) during the preparation for PCI, we performed RIPC procedure by 
      inflation of the cuff of the tonometer to 200 mm Hg and its further deflation on 
      patient's shoulder, thus creating short cycles of controlled ischemia/reperfusion 
      in hand (4 cycles of ischemia/reperfusion for 5/5 minutes respectively). In the 
      second, control group (n=87), the standard primary PCI was performed without the 
      previous RIPC. Evaluation of the endothelial function was performed on the 2-7th 
      day after admission using the endothelium - dependent flow - mediated dilatation 
      test (FMD) of the brachial artery. Primary endpoints in this study included the 
      presence of ED, in - hospital mortality, life - threatening arrhythmias 
      (ventricular fibrillation/ventricular tachycardia after first 24 hours upon 
      admission), stent thrombosis, clinical signs of heart failure, and a combined 
      endpoint consisting of all the listed above. RESULTS: The median values for 
      FMD-test did not differ significantly between the study groups upon admission. 
      Assessment of the FMD of the brachial artery on the 2-7th day after PCI showed 
      that among the patients who underwent RIPC there was a significantly lower 
      percentage of patients with ED than in the patients with STEMI who did not 
      undergo RIPC before PCI (43.1% vs. 75.8% respectively, p=0.0001). We found a 
      significant reduction in the incidence of heart failure and of combined endpoint 
      in the group of patients without ED compared with patients with ED: 0% vs. 9.3% 
      (n=7; p=0.023) and 3.8% (n=2) vs. 16% (n=12; p=0.032) respectively. When 
      assessing the effect of RIPC on hospital prognosis, we also found a significant 
      decrease in the incidence of heart failure and a trend towards a decrease in the 
      combined endpoint in the group of patients who underwent RIPC compared to the 
      control group: 1.5% (n=1) vs. 9.7% (n=6; p=0.045) and 6.2% (n=4) vs. 16.1% (n=10; 
      p=0.073) respectively. CONCLUSION: Performance of RIPC before the primary PCI 
      significantly reduces the incidence of ED in patients with STEMI on the 2-7th day 
      of the disease onset. The presence of ED in patients with STEMI is associated 
      with a significant increase in the incidence of heart failure and of the combined 
      endpoint during in - hospital period. RIPC significantly reduces the incidence of 
      heart failure in patients with STEMI during in - hospital period.
FAU - Manchurov, V N
AU  - Manchurov VN
AD  - A.I. Evdokimov Moscow State University of Medicine and Dentistry.
FAU - Lebedeva, A M
AU  - Lebedeva AM
AD  - A.I. Evdokimov Moscow State University of Medicine and Dentistry.
FAU - Ryazankina, N B
AU  - Ryazankina NB
AD  - A.I. Evdokimov Moscow State University of Medicine and Dentistry.
FAU - Vasilieva, E Y
AU  - Vasilieva EY
AD  - A.I. Evdokimov Moscow State University of Medicine and Dentistry.
FAU - Shpektor, A V
AU  - Shpektor AV
AD  - A.I. Evdokimov Moscow State University of Medicine and Dentistry.
LA  - rus
PT  - Journal Article
DEP - 20200115
PL  - Russia (Federation)
TA  - Ter Arkh
JT  - Terapevticheskii arkhiv
JID - 2984818R
SB  - IM
MH  - Humans
MH  - *Ischemic Preconditioning
MH  - *Myocardial Infarction
MH  - *Percutaneous Coronary Intervention
MH  - Prospective Studies
MH  - *ST Elevation Myocardial Infarction
MH  - Treatment Outcome
OTO - NOTNLM
OT  - endothelial dysfunction
OT  - myocardial infarction
OT  - preconditioning
EDAT- 2020/07/01 06:00
MHDA- 2020/09/18 06:00
CRDT- 2020/06/30 06:00
PHST- 2020/04/16 00:00 [received]
PHST- 2020/06/30 06:00 [entrez]
PHST- 2020/07/01 06:00 [pubmed]
PHST- 2020/09/18 06:00 [medline]
AID - 10.26442/00403660.2020.01.000140 [doi]
PST - epublish
SO  - Ter Arkh. 2020 Jan 15;92(1):10-14. doi: 10.26442/00403660.2020.01.000140.