الفهرس 
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Abstract
Elective percutaneous coronary intervention (PCI) is associated with troponin release in approximately one third of cases. Troponin release is a sensitive and specific marker of myocyte necrosis and infarction resulting from a form of ischemia/reperfusion injury, downstream embolization of atheromatous material, and coronary side-branch occlusion.
A number of studies have demonstrated that procedure related troponin release is associated with subsequent cardiovascular events. Conditioning the heart to tolerate the effects of acute ischaemia-reperfusion injury can be initiated through the application of several different mechanical and pharmacological strategies.
Transient sublethal episodes of ischemia before a prolonged ischemia/reperfusion injury, known as ischemic preconditioning (IPC), have been shown to reduce the extent of myocardial infarction (MI).This protection not only acts locally but also can protect distant tissues, a phenomenon known as remote IPC, and limits MI size in animal models.
Ischemic preconditioning is innate physiologic adaptive process that renders the myocardium more resistant to potentially lethal ischemic injury.
This protection not only acts locally but also can protect distant tissues, a phenomenon known as remote IPC, and limits MI size in animal models.
Aim of the work:
Assessment and comparison of different methods of remote ischaemic preconditioning to reduce cardiac myonecrosis as measured by quantative cardiac troponin I (TnI) after elective percutaneous coronary intervention (PCI) and to reduce major adverse cardiac event rate (MACE Rate) at 6 months follow up.
Patients selection
The study included 120 patients with significant coronary artery stenosis as documented by coronary angiography who were referred for elective PCI in National heart institute in the period between June 2013 and June 2014.
The Inclusion criteria were: Patients with significant coronary artery stenosis as documented by coronary angiography who were referred for elective PCI and Age 18 years or older.
The Exclusion criteria were: Emergency PCI, elevation of cardiac troponin I (cTnI) before PCI taken at the preadmission clinic, women of child-bearing age, nicorandil or glibenclamide use, severe co morbidity or estimated life expectancy less than 6 months, left ventricular ejection fraction less than 40%, Left main stem stenosis requiring coronary bypass surgery and systemic hypotension (systolic <90 mmHg) or cardiogenic shock.
patients will be divided into three groups:
Group A: will include 40 patients receiving multiple remote IPC before arrival in the catheter laboratory (induced by three 5- minute inflations of a blood pressure cuff to 200 mm Hg around upper arm, followed by 5-minute deflations to allow reperfusion).
Group B: will include 40 patients receiving multiple remote IPC before arrival in the catheter laboratory (induced by three 5- minute inflations of a blood pressure cuff to 200 mm Hg around upper thigh, followed by 5-minute deflations to allow reperfusion).
Group C: will include 40 patients will not receiving a remote IPC (control group)
Methods:
Patients who will meet the selection criteria and participate in the study will be subjected to:
1. Thorough history taking including (age, sex, special habits of medical importance, presence of HTN, Diabetes mellitus, hyperlipidemia, the medication prescribed and family history of ischaemic heart disease).
2. Examination: general and local examination.
3. Kidney function tests.
4. 12-lead surface ECG.
5. Cardiac enzyme measurements: Venous blood samples will be collected serially before and 16 hours after PCI. cardiac troponin I levels will be measured.
6. Percutaneous coronary intervention
Follow up after 6 months:
For major adverse cardiac event rate (MACE Rate).
Results:
This is a prospective study that will enroll a total number of (120) symptomatic patients with coronary heart disease and scheduled for elective percutaneous coronary intervention. Patients will be randomized into 3 groups, Group A will include 40 patients who will undergo remote Ischemic Preconditioning immediately before PCI through the upper arm, group B will include 40 patients who will undergo remote Ischemic Preconditioning immediately before PCI through the upper thigh and group C (the control group) will include 40 patients who will not undergo Remote Ischemic Preconditioning