Remote ischemic post-conditioning by serial balloon inflations during PCI significantly reduced acute kidney injury compared to a sham procedure (12.4% vs 29.5%; OR 0.34; 95% CI 0.16-0.71; P=0.002).
RCT (n=225)
Effect estimate: OR 0.34 (95% CI 0.16 to 0.71)
Absolute Event Rate: 12.4% vs 29.5%
p-value: p=0.002
OBJECTIVES: The aim of the present study was to assess the efficacy of remote ischemic post-conditioning (RIPC) by repeated intermittent balloon inflations in preventing acute kidney injury (AKI) in patients with a non-ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention (PCI). BACKGROUND: AKI complicating PCI is associated with increased morbidity and mortality. Remote ischemic preconditioning, using cycles of upper limb ischemia-reperfusion as a conditioning stimulus, has been recently shown to prevent AKI in patients undergoing elective coronary angiography. METHODS: Eligible patients were randomized to receive RIPC by cycles of inflation and deflation of the stent balloon during PCI or a sham procedure (control patients). The primary endpoint was AKI, defined as an increase of ≥ 0.5 mg/dl or ≥ 25% in serum creatinine within 96 h from PCI. The 30-day rate of death or re-hospitalization for any cause was one of the secondary endpoints. RESULTS: A total of 225 patients were included (median age, 68 years; 36% female). The AKI rate in the RIPC group was 12.4% versus 29.5% in the control group (p = 0.002; odds ratio: 0.34; 95% confidence interval: 0.16 to 0.71). The number needed to treat to avoid 1 case of AKI was 6 (95% confidence interval: 3.6 to 15.2). The 30-day rate of death or re-hospitalization for any cause was 22.3% in the control group versus 12.4% in RIPC patients (p = 0.05). CONCLUSIONS: RIPC by serial balloon inflations and deflations during PCI was found to confer protection against AKI in patients with a non-ST-segment elevation myocardial infarction undergoing PCI. The reduction in the rate of AKI translated into a clear trend (of borderline significance) toward better 30-day clinical outcome.
Deftereos et al. (Thu,) conducted a rct in Non-ST-segment elevation myocardial infarction undergoing PCI (n=225). Remote ischemic post-conditioning (RIPC) vs. Sham procedure was evaluated on Acute kidney injury (AKI), defined as an increase of ≥ 0.5 mg/dl or ≥ 25% in serum creatinine within 96 h from PCI (OR 0.34, 95% CI 0.16 to 0.71, p=0.002). Remote ischemic post-conditioning by serial balloon inflations during PCI significantly reduced acute kidney injury compared to a sham procedure (12.4% vs 29.5%; OR 0.34; 95% CI 0.16-0.71; P=0.002).
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