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Renoprotective Effect of Remote Ischemic Post-Conditioning by Intermittent Balloon Inflations in Patients Undergoing Percutaneous Coronary Intervention

Selected in Journal of the American College of Cardiology by M Bollati

References

Authors

Deftereos S, Giannopoulos G, Tzalamouras V, Raisakis K, Kossyvakis C, Kaoukis A, Panagopoulou V, Karageorgiou S, Avramides D, Toutouzas K, Hahalis G, Pyrgakis V, Manolis AS, Alexopoulos D, Stefanadis C, Cleman MW.

Reference

J Am Coll Cardiol 2013;61:1949–55

Link

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My Comment

What is known

Remote ischemic post-conditioning (RIPC) is an old phenomenon. Old, but not deeply known, both in its underlying mechanisms and in its clinical relevance.

It has been tested in acute myocardial infarction and in percutaneous coronary intervention, leading to inconsistent conclusions.

Considering the acute kidney injury (AKI) due contrast injection prognostic importance after percutaneous coronary intervention (PCI), mainly due to hypoxic kidney damage, authors evaluated the results of randomized conditioning stimulus (inflation cycles of coronary ballon during PCI in non STEMI patients).

Major findings

  • 225 patients enrolled
  • AKI rate (increase of >0.5mg/dl or >25% in serum creatinine within 96 h from PCI) was 12.4% in the RICP group versus 29.5% in the control group (p < 0.002; odds ratio: 0.34), with 6 as number needed to treat to avoid 1 case of AKI
  • The 30-day rate of death or re-hospitalization for any cause differed significantly, with 22.3% in the control group versus 12.4% in RIPC patients (p<0.05)

My comments

“L'essentiel est invisible pour les yeux”. There is a side you cannot see, everyday. And the trial by Deftereos et al. helps us discovering more: the comfirmation of AKI prognostic significance; the strengthening of RICP role preventing AKI. And the small number of patients we have to treat (without risk) gaining an advantage (just six).

What are we waiting for?

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