Purpose

Remote ischemic periconditioning (RIPC) has demonstrated cardioprotective effects and improved clinical outcomes as an adjunct to emergent percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). However, whether RIPC affects the cardiac sympathetic nerve activity in patients with STEMI remains unclear. This study investigated the effects of RIPC on cardiac sympathetic nerve activity in patients with STEMI.

Methods

We prospectively assigned patients with STEMI who underwent emergent PCI to receive RIPC or no procedure (control group) upon arrival at the cardiac catheterization laboratory. The primary endpoint was cardiac sympathetic nerve activity assessed through the washout rate (WR) in cardiac ¹²³I-metaiodobenzylguanidine (¹²³I-MIBG) imaging.

Results

Patients in the RIPC (n = 62) and control (n = 60) groups had similar demographic and clinical characteristics at baseline. Multivariable linear regression models revealed that the culprit lesion of the left anterior descending artery and hemoglobin level were significantly and independently associated with WR at discharge. WRs of the groups differed insignificantly at discharge. However, the RIPC group (n = 49) showed significantly lower WR than the control group (n = 47) at 1 year after discharge (p = 0.027). In the single-photon emission computed tomography analysis at 1 year after discharge, the RIPC group demonstrated significantly higher late uptake (p = 0.021) and lower WR (p = 0.013) in the nonculprit lesion, with a non-significant decrease in WR for the culprit lesion.

Conclusion

RIPC can suppress augmented cardiac sympathetic nerve activity in patients with STEMI, particularly in nonculprit lesions.

中文翻译：

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远程缺血性周围调节抑制急性心肌梗死中的心脏交感神经激活：一项随机对照试验

 目的

远程缺血性围膜调节 （RIPC） 已证明具有心脏保护作用并改善了临床结局，作为 ST 段抬高型心肌梗死 （STEMI） 患者紧急经皮冠状动脉介入治疗 （PCI） 的辅助治疗。然而，RIPC 是否影响 STEMI 患者的心脏交感神经活动仍不清楚。本研究调查了 RIPC 对 STEMI 患者心脏交感神经活动的影响。

 方法

我们前瞻性地将接受紧急 PCI 的 STEMI 患者在到达心导管实验室后接受 RIPC 或不进行手术 （对照组）。主要终点是通过心脏 ¹²³I-间碘苄基胍 （¹²³I-MIBG） 成像中的清除率 （WR） 评估的心脏交感神经活动。

 结果

RIPC （n = 62） 和对照组 （n = 60） 的患者在基线时具有相似的人口统计学和临床特征。多变量线性回归模型显示，左前降支罪魁祸首病变和血红蛋白水平与出院时 WR 显著且独立相关。出院时各组的 WRs 差异不显著。然而，RIPC 组 （n = 49） 在出院后 1 年显示 WR 显着低于对照组 （n = 47） （p = 0.027）。在出院后 1 年的单光子发射计算机断层扫描分析中，RIPC 组在非罪犯病灶中表现出显着较高的晚期摄取 （p = 0.021） 和较低的 WR （p = 0.013），而罪犯病灶的 WR 没有显着降低。

 结论

RIPC 可以抑制 STEMI 患者增强的心脏交感神经活动，尤其是在非罪魁祸首病变中。