西班牙一项研究表明，远隔缺血后适应（RIP）未能减轻择期经皮冠脉介入（PCI）相关性损伤，并且接受RIP治疗的糖尿病患者PCI相关性心肌梗死（PCI-MI）发生率更高。论文7月12日在线发表于《心脏》（Heart）。
此项研究共纳入232例因稳定或不稳定心绞痛而接受择期PCI的患者，并随机给予RIP或安慰剂治疗。主要转归指标为24小时肌钙蛋白I峰浓度；次要转归指标为住院治疗、因稳定性心绞痛或急性冠脉综合征行PCI以及随访1年后死亡率。对应用RIP的糖尿病患者进行特别研究。
结果显示，受试者平均年龄为64.6岁，42%伴有糖尿病。RIP和对照组患者的肌钙蛋白峰值分别为0.476和0.478 ng/mL（P=0.99），PCI-MI发生率分别为36%和30.8%（P=0.378）。糖尿病RIP患者的PCI-MI发生率更高（OR 2.7；P=0.027）。RIP和安慰剂组的次要转归发生率分别为11.7%和10.8%（P=0.907）。（生物谷Bioon.com）
生物谷推荐英文摘要：
Heart doi:10.1136/heartjnl-2013-304172
Remote ischaemic postconditioning: does it protect against ischaemic damage in percutaneous coronary revascularisation? Randomised placebo-controlled clinical trial
Fernando Carrasco-Chinchilla, Antonio J Munoz-García, Antonio Domínguez-Franco, Gloria Millán-Vázquez, Alicia Guerrero-Molina, Carmen Ortiz-García, Alfredo Enguix-Armada, Juan H Alonso-Briales, Jose M Hernández-García, Eduardo de Teresa-Galván, Manuel F Jiménez-Navarro
Objective Determine whether remote ischaemic postconditioning (RIP) protects against percutaneous coronary intervention-related myocardial infarction (PCI-MI).
Design Single-centre, randomised, blinded to the researchers, clinical trial. ClinicalTrials.gov (NCT 01113008).
Setting Tertiary hospital centre.
Patients 232 patients underwent elective PCI for stable or unstable angina.
Interventions Patients were randomised to RIP (induction of three 5-min cycles of ischaemia in the arm after the PCI) versus placebo.
Main outcome measures The primary outcome measure was the peak 24-h troponin I level. PCI-MI was defined by an elevation of troponin values >3 or >5 of the 99th percentile according to the classical or the new definition. The secondary outcome measure was hospital admission, PCI for stable angina or acute coronary syndrome and mortality after 1?year of follow-up. The use of RIP in diabetic patients was specifically studied.
Results The mean age was 64.6years, and 42% were diabetic. The peak troponin in the RIP patients was 0.476 vs 0.478?ng/mL (p=0.99). PCI-MI occurred in 36% of the RIP patients versus 30.8% in the placebo group (p=0.378). Diabetic RIP patients had more PCI-MI (new definition): OR 2.7; 95% CI 1.10 to 6.92; p=0.027. The secondary outcome measure was seen in 11.7% of the RIP patients versus 10.8% in the placebo group (p=0.907).
Conclusions RIP did not reduce the damage associated with elective PCI or cardiovascular events during the follow-up. The diabetic population who underwent RIP had more PCI-MI.
