Remote Ischemic Conditioning in Patients Undergoing Primary Percutaneous Coronary Intervention

Myocardial infarction (MI) generally refers to segmental (regional) myocardial necrosis, typically endocardial in location, secondary to occlusion of an epicardial artery.

Primary percutaneous coronary intervention (PPCI) is a reperfusion therapy that is carried out in patients who usually have ST-segment elevation MI (STEMI) within a specific time window.

During ischemia, metabolic acidosis occurs due to anaerobic metabolism, and ischemic injury ensues. After restoration of blood supply, reactive oxygen species (ROS) production and local inflammation increase secondary injury.

Inclusion criteria

• Age more than 18 and less than 75 years old.
• Both sexes.
• Patients with new ST-segment elevation at the J-point in V1:V6 leads with the cut-point: ≥ 1mm other than leads V2-V3 where the following cut-points apply: ≥ 2mm in men ≥ 40 years; ≥ 2.5mm in men < 40 years, or ≥ 1.5mm in women regardless of age.
• Patients with new left bundle branch block (LBBB).

Exclusion criteria

• ST-segment elevation myocardial infarction (STEMI) with cardiogenic shock.
• Severe comorbidities (uncontrolled hypertension, morbid obesity, recent cerebrovascular stroke, respiratory failure, sepsis, and stage 4 & 5 malignancy).
• End-stage renal disease on hemodialysis.
• Previous coronary artery bypass graft surgery (CABG).
• Myocardial infarct within the previous 30 days.
• Multi-vessel coronary artery disease.
• Failure of culprit vessel recanalization.
• Conditions precluding use of remote conditioning ie: paresis of upper limb.
• Life expectancy of less than 1 year due to a non-cardiac pathology.
• Patients who receive nephrotoxic drugs such as non-steroidal anti-inflammatory drugs and aminoglycosides.