الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Ischemic heart disease (IHD) maintains its unrelenting grip as the leading cause of death and disability worldwide. ST segment elevation myocardial infarction (STEMI) is the most serious presentation of atherosclerotic coronary artery disease carrying the most hazardous consequences.
The degree of LV dysfunction is the strongest determinant of mortality after STEMI.
Thus, the immediate goal of reperfusion therapy is to restore normal epicardial blood flow promptly, which is achieved most effectively with PPCI.
Paradoxical cardiomyocyte dysfunction, a phenomenon is observed with all modalities of reperfusion including thrombolysis, PCI, CABAG, and cardiac transplantation. Consequently, attention is no longer solely aimed at reducing the acute mortality associated with STEMI but also to limit the downstream consequence of post infarction HF. Ischemia-reperfusion injury (IRI) is believed to account for up to 40-50 % of infarct size and may be a target to prevent evolution to heart failure after STEMI. Several pharmacological alternatives have been attempted to prevent IRI in promising animal experiments; nevertheless, clinical translation has been disappointing. On the opposite side, ischemic conditioning (IC) by short cycles of ischemia-reperfusion applied before, during or after a major ischemic event has clearly been shown to attenuate IRI in various clinical scenarios. Moreover, even so-called remote IC (RIC), which is repeated bouts of limb ischemia, is cardioprotective.
None of previous studies was dedicated to those with anterior STEMI, so the primary objective of our trial is to test the hypothesis that RIC will reduce the infarct size and translated to clinical practice in reduction of major cardiovascular adverse events in patients with anterior STEMI.
Our study was conducted on 50 consecutive patients presented to Alexandria main university hospital with anterior STEMI candidate to PPCI, 25 were preconditioned before reperfusion and 25 were control without preconditioning, and all patients were followed up after one month.
Patients who were eligible for the study were subjected to thorough history taking, physical examination, routine laboratory investigation, and transferred immediately to catheterization lab to have PPCI. All angiographic and PCI details were recorded, then patients transferred to CCU to continue treatment and monitoring for the recommended period of hospital stay. Transthoracic echocardiography and TDI done in the first 24 hours.
Study evaluation points
Demographic data: Age, gender, risk factors to coronary artery disease (diabetes mellitus, dyslipidemia, family history of premature atherosclerosis and hypertension), duration of chest pain, pain to balloon time.
Full clinical assessment; heart rate, blood pressure (systolic &diastolic), Killip class and 12 –lead electrocardiogram (ECG) data analysis.
Routine laboratory data including cardiac markers (CKMB& troponin I) hemoglobin, renal functions done on admission.