Key result
Ischemic preconditioning is linked to ~78% lower 1-year major cardiac events.
Why the study?
Despite strong myocardial protection by ischemic preconditioning observed experimentally, its clinical effects in humans with coronary artery disease remain uncertain.
Does the presence of ischemic preconditioning improve cardiovascular outcomes in patients with symptomatic coronary artery disease?
Cohort (n=229)
Does the presence of ischemic preconditioning improve cardiovascular outcomes in patients with symptomatic coronary artery disease?
The presence of ischemic preconditioning during exercise stress testing is associated with significantly better 1-year cardiovascular outcomes in patients with stable multivessel coronary artery disease.
Answers are grounded in this paper and cite their sources.
Supports ischemic preconditioning as a prognostic marker in CAD; leaves open causal benefit and practice change pending randomized trials.
BACKGROUND: Despite the powerful myocardial protection of ischemic preconditioning (IP) observed in experimental studies, it remains a challenge to observe such protection in humans. Thus, the aim of this study was to evaluate the possible effects of IP on clinical outcomes in patients with coronary artery disease (CAD). PATIENTS AND METHODS: In this cohort study, patients with multivessel CAD, preserved systolic ventricular function, and stable angina were prospectively selected. They underwent two sequential exercise stress tests (EST) to evaluate IP presence. IP was considered present if patients had an improvement in the time to the onset of 1.0-mm STsegment deviation in the second EST. The primary end point was the composite rate of cardiac death, nonfatal myocardial infarction, or revascularization during 1-year follow-up. Patients with (IP+) and without (IP-) the cardioprotective mechanism were compared regarding clinical end points. RESULTS: A total of 229 patients completed EST and had IP evaluated: 165 (72%) were IP+ and 64 (28%) were IP - patients. Of these, 218 patients had complete follow-up. At 1-year, event-free survival regarding the primary end point was 95.5 versus 83.6% (P = 0.0024) and event-free survival regarding cardiac death or myocardial infarction was 99.4 versus 91.7% (P=0.0020), respectively, in IP + and IP - groups. The unadjusted hazard ratio (IP + /IP-) for the primary end point was 4.63 (1.52-14.08). After multivariate analysis, IP was still significantly associated with better clinical outcomes (P = 0.0025). CONCLUSION: This data suggest that IP may contribute to better clinical outcomes in patients with ischemic heart disease.
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Garcia et al. (2019) conducted a cohort in Coronary artery disease (n=229). Ischemic preconditioning vs. Absence of ischemic preconditioning was evaluated on Composite rate of cardiac death, nonfatal myocardial infarction, or revascularization (HR 4.63, 95% CI 1.52-14.08, p=0.0024). Ischemic preconditioning was associated with higher 1-year event-free survival from cardiac death, MI, or revascularization compared to no preconditioning.
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