Remote Ischemic Preconditioning Provides Clinical Benefits by Decreasing Periprocedural Myocardial Injury in Indian Patients

Background: Remote Ischemic Preconditioning (RIPC) in patients undergoing elective Percutaneous Coronary Intervention (PCI) may provide enhanced clinical benefits. However, published studies on PCI induced cardiac damage have yielded conflicting results. Aims: To determine whether RIPC reduces reperfusion injury and cardiac damage in Indian patients undergoing elective PCI. Materials and Methods: This prospective, randomized, control study was conducted among Acute Coronary Syndrome (ACS) patients undergoing PCI from July 2017 to October 2018 in Pt. Jawaharlal Nehru Memorial Medical College, Raipur and Dr. Bhimrao Ambedkar Memorial Hospital, Chhattisgarh. One group received RIPC (three 5-minute inflations and deflations of a standard blood-pressure cuff on the upper arm) at 1 hour before PCI. The other group which did not received RIPC served as control group. Cardiac biomarker release (Troponin-I and Creatine Kinase- MB), Electrocardiographic (ECG) and echocardiographic changes were measured in all patients before and after PCI at different time intervals. Results: A total of 52 patients were randomised and equally distributed into control and RIPC group (26 each). Post PCI, there was 77.29% reduction in mean Area Under Curve (AUC) for Troponin-I in RIPC group (8.84 ± 9.72) compared to control group (38.93 ± 79.11). Also, 64.82% reduction was found in mean AUC of CKMB in RIPC group (179.95 ± 120.7) compared to control group (511.65 ± 701.0). Conclusion: RIPC of the upper arm before primary PCI in patients with ACS could provide protection against cardiac damage and ischemia-reperfusion injury.