The effects of remote ischaemic preconditioning on coronary artery function in patients with stable coronary artery disease

Corcoran, D. et al. (2018) The effects of remote ischaemic preconditioning on coronary artery function in patients with stable coronary artery disease. International Journal of Cardiology, 252, pp. 24-30. (doi:10.1016/j.ijcard.2017.10.082) (PMID:29249435) (PMCID:PMC5761717)

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Abstract

Background: Remote ischaemic preconditioning (RIPC) is a cardioprotective intervention invoking intermittent periods of ischaemia in a tissue or organ remote from the heart. The mechanisms of this effect are incompletely understood. We hypothesised that RIPC might enhance coronary vasodilatation by an endothelium-dependent mechanism. Methods: We performed a prospective, randomised, sham-controlled, blinded clinical trial. Patients with stable coronary artery disease (CAD) undergoing elective invasive management were prospectively enrolled, and randomised to RIPC or sham (1:1) prior to angiography. Endothelial-dependent vasodilator function was assessed in a non-target coronary artery with intracoronary infusion of incremental acetylcholine doses (10−6 , 10−5 , 10−4 mol/l). Venous blood was sampled pre- and post-RIPC or sham, and analysed for circulating markers of endothelial function. Coronary luminal diameter was assessed by quantitative coronary angiography. The primary outcome was the between-group difference in the mean percentage change in coronary luminal diameter following the maximal acetylcholine dose (Clinicaltrials.gov identifier: NCT02666235). Results: 75 patients were enrolled. Following angiography, 60 patients (mean ± SD age 57.5 ± 8.5 years; 80% male) were eligible and completed the protocol (n = 30 RIPC, n = 30 sham). The mean percentage change in coronary luminal diameter was −13.3 ± 22.3% and −2.0 ± 17.2% in the sham and RIPC groups respectively (difference 11.32%, 95%CI: 1.2– 21.4, p = 0.032). This remained significant when age and sex were included as covariates (difference 11.01%, 95%CI: 1.01– 21.0, p = 0.035). There were no between-group differences in endothelial-independent vasodilation, ECG parameters or circulating markers of endothelial function. Conclusions: RIPC attenuates the extent of vasoconstriction induced by intracoronary acetylcholine infusion. This endothelium-dependent mechanism may contribute to the cardioprotective effects of RIPC

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and McConnachie, Dr Alex and Collison, Dr Damien and Welsh, Dr Paul and Hennigan, Dr Barry and Mccartney, Dr Peter and Oldroyd, Dr Keith and Corcoran, Dr David and Young, Dr Robin and Sattar, Professor Naveed
Authors: Corcoran, D., Young, R., Cialdella, P., McCartney, P., Bajrangee, A., Hennigan, B., Collison, D., Carrick, D., Shaukat, A., Good, R., Watkins, S., McEntegart, M., Watt, J., Welsh, P., Sattar, N., McConnachie, A., Oldroyd, K.G., and Berry, C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:International Journal of Cardiology
Publisher:Elsevier
ISSN:0167-5273
ISSN (Online):1874-1754
Published Online:14 December 2017
Copyright Holders:Copyright © 2017 The Authors
First Published:First published in International Journal of Cardiology 252: 24-30
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
628691Microvascular Dysfunction in Patients with Angina: The CE-MARC2 Microvascular SubstudyColin BerryBritish Heart Foundation (BHF)FS/14/15/30661RI CARDIOVASCULAR & MEDICAL SCIENCES
692781A prospective comparison of the diagnostic utility of invasive coronary physiological indices and quantitative perfusion MRI in patients with coronary heart disease...Keith OldroydBritish Heart Foundation (BHF)PG/14/97/31263RI CARDIOVASCULAR & MEDICAL SCIENCES
617771BHF centre of excellenceRhian TouyzBritish Heart Foundation (BHF)RE/13/5/30177RI CARDIOVASCULAR & MEDICAL SCIENCES