Effectof Remote Ischemic Preconditioning On Myocardium In Patients With Coronary Heart Disease Undergoing Elective PCI

Objective:To investigate whether remote ischaemic preconditioning(RIPC)can protect myocardium of patients with coronary heart disease undergoing elective percutaneous coronary intervention(PCI),as well as its related mechanism.Part I,to observe the effect of RIPC on myocardial injury and inflammatory reaction in patients after elective PCI.The indicators of observation are hs-troponin I(hs-c Tn I),creatine kinase isoenzyme(CK-MB),and high-sensitivity C-reactive protein(hs-CRP).The prevalence of type 4a myocardial infarctio(4a MI)were compared between the two groups;Part II,to investigate the effect of RIPC on myocardial microcirculation and evaluate the NO,ET-1,NO/ET-1 in patients afterelective PCI with single vessel disease.Finally,togerther two parts to explore the "riboexpansion effect" of RIPC on coronary myocardial circulation,as protective effect of perioperative myocardial.Methods:One hundred and thirty-six patients with coronary artery disease undergoing elective PCI were selected from December,2016 to September,2017 from Department of Cardiology,Sichuan Provincial People's Hospital,divided them into 2 groups randomly: 66 in the RIPC group and 70 in the control group.Patients were admitted to conventional drug therapy(anti-platelet,beta-blockers,nitrates,calcium antagonists,etc.)Preoperative ECG echocardiography was performed in all patients.All patients received ECG check after surgery two hours.High-sensitivity troponin(hs-c Tn I),creatine kinase isoenzyme(CK-MB),and high sensitivity-CRP were checked before and 24 h after PCI in all patients.All patients were followed up three months.Then 26 patients were selected from RIPC group with coronary artery single-vessel disease,and measure Fractional flow reserve(FFR),baseline index of microcirculator resistance(IMR0),IMR1 measured after RIPC intervention,IMR2 measured under of vasodilator adenosine triphosphate,and 26 RIPCs Nitric oxide(NO),Endothelin-1(ET-1),and NO/ET-1 levels in the aortic sinus within 10 min before and after RIPC.RIPCmethod: The pneumatic medical cuff was inflated to a pressure of 200 mm Hg for 5 minutes,followed by 5 minutes of deflation to allow reperfusion in upper/lower limb.This procedure was repeated 5 times,takes 25 mins.Results:Part ?: 1.There was no significant difference between the RIPC group and the control group in terms of age,gender,BMI,blood pressure,heart rate,and smoking(P>0.05).There was no statistical difference between the two groups in the history of hyperlipidemia,diabetes,angina pectoris,hypertension,history of old myocardial infarction,and PCI,CABG(P>0.05),no difference between two groups in aspects,ALT,Scr,e-GFR,LDL-C,BNP,LVEF,LV(d),red blood cells,and platelets(P>0.05),and still no difference onthe antiplatelet medication and other systemic medications between groups.2.The characteristics related to PCI,the total balloon inflation time,number of expansions,coronary angiography,vascular site,and lesion ACC/AHA classification during stenting performed no significant difference betwwen two groups(P>0.05).There was no difference in expansion pressure,number of stent implantation,postoperative TIMI flow,and postoperative low molecular weight heparin(P> 0.05).3.There was no significant gap onthe baseline clinical levels like hs-c Tn I,CK-MB,and hs-CRP between RIPC and control group(P>0.05).The level of hs-c Tn I was less in the RIPC group than in the control group at 24 hours after PCI(P=0.033).The post-operative level of hs-CRP was less in the RIPC group than in the control group at 24 hours after PCI(P=0.003).The post-operative level of CK-MB did not differbetween the two groups at 24 hours after PCI(P=0.8).There was no significant difference in therate of 4a MI,ST-segment changes,and ventricular arrhythmias between two groups(P>0.05).Part ?: 1.26 patients in this part,13 cases(50%)with LAD disease,6 cases(23.07%)with LCX and 7 cases with RCA disease.FFR: 0.74(0.69,0.79)U,IMR0 U: 84.05(78.10,90.24),IMR1 U: 61.67(56.48 68.30)IMR2 U: 18.0(15.74,20.26),There were 23 cases(88.5%)with IMR2 less than 25 U;2 cases(11.54%)in the 25-30 U gray area;and 1 case(7.7%)with more than 30 U as microcirculation disorder.2.The baseline NO was 63.28±9.27 ug/mlbefore RIPC treatment,and it was 63.82±9.34 umol/l,within 10 min after RIPC.There was no significant difference between the two(P=0.101);ET-1 after RIPC was lower than RIPC before,there was significant difference(116.87 ± 11.6 VS 114.56 ± 9.34,P=0.006)).The ratio of NO/ET-1 after RIPC was lower than before RIPC based ratios 0.54±0.1VS 0.56±0.1,P=0.003).Conclusions: 1.Some of coronary heart disease patients undergoing elective PCI may lead to myocardial injury,inflammatory reaction and 4a MI.2.RIPC can reduce myocardial injury and inflammatory response in patients with elective PCI,but did not reduce the incidence of 4a MI.3.RIPC can balance the ratio of NO/ET-1 in patients with elective PCI,improve myocardial microcirculation,and have a softly "vasodilator" effect.4.RIPC reduced the occurrence of perioperative chest pain in patients with elective PCI,did not reduce rate of adverse cardiac events during follow-up(MACE).5.RIPC is safe during the intraoprative period of PCI.