A study to find out the effect of remote ischemic post conditioning of lower limb in patients of acute myocardial infarction undergoing primary percutaneous coronary intervention

Sreedhara R., Vishwa Deepak Tripathi


Background: Reperfusion therapy of affected myocardium is among the most successful method for infarct size reduction and achieving the better outcome in patients with ST-segment elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (pPCI) is among best procedures for successful reperfusion therapy which has effect in reduction of size of infarct, maintaining ventricular function for better outcome. In this study, authors were aimed to assess whether remote ischemic post-conditioning (RIPC) of lower limb could reduce enzymatic infarct size in patients with acute STEMI undergoing pPCI.

Methods: A case control, cross sectional, hospital based randomized study was carried out in Institute of Cardiovascular Sciences, IPGMER, Kolkata, from February 2014 to October 2015. Total 40 patients (20 cases and 20 controls) who were undergoing primary PCI for acute myocardial infarction were taken for study. In the active treatment group, the protocol was started with thrombectomy. The lower limb was exposed to 3 cycles of ischemia/reperfusion, each obtained by 5 min cuff inflation at 200mmHg, followed by 5 min complete deflation. End point of the study will be enzymatic infarct size assessed by the area under the curve of creatine kinase-myocardial band (CK-MB) release.

Results: The AUC of serum CK release during the first 72 hours of reperfusion was significantly reduced (p=0.0341) in the post-conditioned group compared with the control group, averaging 9632 units in postconditioned compared with 13493 units in control group which represented 26% of reduction of infarct size.

Conclusions: Remote ischemic post conditioning of lower limb significantly improves blush grading and enzymatic infarct size reduction with a trend towards significant reduction of mean ST segment deviation.


Acute myocardial infarction, pPCI, RIPC, STEMI

Full Text:



Crimi G, Pica S, Raineri C, Bramucci E, De Ferrari GM, Klersy C, et al. Remote ischemic post-conditioning of the lower limb during primary percutaneous coronary intervention safely reduces enzymatic infarct size in anterior myocardial infarction: a randomized controlled trial. JACC Cardiovasc Interv. 2013;6(10):1055-63.

Zijlstra F, Hoorntje JC, de Boer MJ, Reiffers S, Miedema K, Ottervanger JP, et al. Long-term benefit of primary angioplasty as compared with thrombolytic therapy for acute myocardial infarction. N Eng J Med. 1999;341:1413-9.

Yellon DM, Hausenloy DJ. Myocardial reperfusion injury. N Engl J Med. 2007;357:1121-35.

Zhao ZQ, Corvera JS, Halkos ME, Kerendi F, Wang NP, Guyton RA, et al. Inhibition of myocardial injury by ischemic postconditioning during reperfusion: comparison with ischemic preconditioning. Am J Physiol Heart Circ Physiol. 2003;285:H579-88.

Przyklenk K, Bauer B, Ovize M, Kloner R, Whittaker P. Regional ischemic “preconditioning” protects remote virgin myocardium from subsequent sustained occlusion. Circulation. 1993;87:893-9.

Andreka G, Vertesaljai M, Szantho G, Font G, Piroth Z, Fontos G, et al. Remote ischaemicpostconditioning protects the heart during acute myocardial infarction in pig. Heart. 2007;93:749-52.

Park HJ, Chang K, Park CS, Jang SW, Ihm SH, Kim PJ, et al. Coronary collaterals: The role of MCP-1 duringtheearlyphase of acute myocardial infarction. Int J Cardiol. 2008;130:409.

Opie LH, Lecour S. Delayed postconditioning: Cardioprotection at the limit? Circulation. 2011;124:1315.

Silva C, Cacciavillani L, Corbetti F, De Lazzari M, PerazzoloMarra M, Iliceto S, et al. Natural time course of myocardial infarctionatdelayed enhancement magnetic resonance. Int J Cardiol. 2011;148:e10.

Gritsopoulos G, Iliodromitis EK, Zoga A. Remote postconconditioning is more potent than classic postconditioning in reducing infarct size in anesthetized rabbits. Cardiovasc Drug Ther. 2009;23:193-8.

Kloner RA and Jennings RB. Consequences of brief ischemia: stunning, preconditioning, and their clinical implications. Part 1. Circulation. 2001;104:2981-9.

Mallory FB, White PD, Salcedo-Salgar J. The speed of healing of myocardial infarction: A study of the pathologic anatomy in 72 cases. Am Heart J. 1939;18:647.

deLemos JA, Braunwald E. ST segment resolution as a tool for assessingthe efficacy of reperfusion therapy. J Am Coll Cardiol. 2001;30:1283-94.