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Myocardial protection by remote ischemic preconditioning in elective PCI: Effect of ageing
International Journal of Cardiology 243 (2017) 105
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Myocardial protection by remote ischemic preconditioning in elective PCI: Effect of ageing Baohui Lou a,⁎, Haiyang Gao b, Chenghui Zhou c a
Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, China c Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China b
a r t i c l e
i n f o
Article history: Received 23 March 2017 Accepted 30 March 2017 Keywords: Remote ischemic preconditioning Percutaneous coronary intervention Myocardial protection Ageing
method and also found an attenuated renal effect of RIPC in ageing populations (range, 47.0–76.0 years) undergoing cardiac surgery [5]. Hence, the negative myocardial protection by RIPC in this study may attribute to the enrollment of patients with high age. Although they conducted a logistic analysis including age, the categorized method (b65.0 or ≥ 65.0 years) is not appropriate for the wide ranging age (60.0–80.0 years), and an additional analysis with continuous variable of age may be more informative. Based on the current evidence, we believe that RIPC remains a useful cardioprotective strategy in elective PCI, especially along with the increasing population with premature coronary artery disease.
Dear Editor,
Conflict of interest
We read with great interest the well-designed paper by Miyoshi et al. online published in IJC in Feb 10, 2017 [1]. They randomized 129 remote ischemic preconditioning (RIPC) treated patients and 133 controls undergoing elective percutaneous coronary intervention (PCI), and found a negative cardiac effect in enzyme level (troponin and/or CK-MB) and other ischemia-related events. The mean age was 70.7 (range, 60.9 to 80.5) years in the RIPC group, and 70.3 (range, 60.2 to 80.4) years in the control group. There has always been a concern whether cardioprotective potentials of ischemic conditioning established in young animals could be translated into the ageing subjects in the clinical practice [2]. In our previous meta-analysis with ischemic postconditioning in primary PCI, age was well balanced between RIPC and control group in each included trials, whereas found to be negatively correlated with the effect size of left ventricular ejection fraction (%) (coefficient = −1.34; P = 0.025) during the range of 55.0 to 64.0 years [3,4]. Recently, we used similar
The authors report no relationships that could be construed as a conflict of interest.
⁎ Corresponding author. E-mail address: [email protected] (B. Lou).
http://dx.doi.org/10.1016/j.ijcard.2017.03.142 0167-5273/© 2017 Elsevier B.V. All rights reserved.
References [1] T. Miyoshi, K. Ejiri, K. Kohno, et al., Effect of remote ischemia or nicorandil on myocardial injury following percutaneous coronary intervention in patients with stable coronary artery disease: a randomized controlled trial, Int. J. Cardiol. 236 (2017) 36–42. [2] G. Heusch, T. Rassaf, Time to give up on cardioprotection? A critical appraisal of clinical studies on ischemic pre-, post-, and remote conditioning, Circ. Res. 119 (2016) 676–695. [3] C. Zhou, Y. Yao, Z. Zheng, et al., Stenting technique, gender, and age are associated with cardioprotection by ischaemic postconditioning in primary coronary intervention: a systematic review of 10 randomized trials, Eur. Heart J. 33 (2012) 3070–3077. [4] C. Zhou, L. Li, Age may contribute to the negative cardiac effect of postconditioning on STEMI patients, Int. J. Cardiol. 162 (2012) 59–60. [5] C. Zhou, H. Bulluck, N. Fang, L. Li, D.J. Hausenloy, Age and surgical complexity impact on renoprotection by remote ischemic preconditioning during adult cardiac surgery: a meta analysis, Sci. Rep. 7 (2017) 215.
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Myocardial protection by remote ischemic preconditioning in elective PCI: Effect of ageing Baohui Lou a,⁎, Haiyang Gao b, Chenghui Zhou c a
Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, China c Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China b
a r t i c l e
i n f o
Article history: Received 23 March 2017 Accepted 30 March 2017 Keywords: Remote ischemic preconditioning Percutaneous coronary intervention Myocardial protection Ageing
method and also found an attenuated renal effect of RIPC in ageing populations (range, 47.0–76.0 years) undergoing cardiac surgery [5]. Hence, the negative myocardial protection by RIPC in this study may attribute to the enrollment of patients with high age. Although they conducted a logistic analysis including age, the categorized method (b65.0 or ≥ 65.0 years) is not appropriate for the wide ranging age (60.0–80.0 years), and an additional analysis with continuous variable of age may be more informative. Based on the current evidence, we believe that RIPC remains a useful cardioprotective strategy in elective PCI, especially along with the increasing population with premature coronary artery disease.
Dear Editor,
Conflict of interest
We read with great interest the well-designed paper by Miyoshi et al. online published in IJC in Feb 10, 2017 [1]. They randomized 129 remote ischemic preconditioning (RIPC) treated patients and 133 controls undergoing elective percutaneous coronary intervention (PCI), and found a negative cardiac effect in enzyme level (troponin and/or CK-MB) and other ischemia-related events. The mean age was 70.7 (range, 60.9 to 80.5) years in the RIPC group, and 70.3 (range, 60.2 to 80.4) years in the control group. There has always been a concern whether cardioprotective potentials of ischemic conditioning established in young animals could be translated into the ageing subjects in the clinical practice [2]. In our previous meta-analysis with ischemic postconditioning in primary PCI, age was well balanced between RIPC and control group in each included trials, whereas found to be negatively correlated with the effect size of left ventricular ejection fraction (%) (coefficient = −1.34; P = 0.025) during the range of 55.0 to 64.0 years [3,4]. Recently, we used similar
The authors report no relationships that could be construed as a conflict of interest.
⁎ Corresponding author. E-mail address: [email protected] (B. Lou).
http://dx.doi.org/10.1016/j.ijcard.2017.03.142 0167-5273/© 2017 Elsevier B.V. All rights reserved.
References [1] T. Miyoshi, K. Ejiri, K. Kohno, et al., Effect of remote ischemia or nicorandil on myocardial injury following percutaneous coronary intervention in patients with stable coronary artery disease: a randomized controlled trial, Int. J. Cardiol. 236 (2017) 36–42. [2] G. Heusch, T. Rassaf, Time to give up on cardioprotection? A critical appraisal of clinical studies on ischemic pre-, post-, and remote conditioning, Circ. Res. 119 (2016) 676–695. [3] C. Zhou, Y. Yao, Z. Zheng, et al., Stenting technique, gender, and age are associated with cardioprotection by ischaemic postconditioning in primary coronary intervention: a systematic review of 10 randomized trials, Eur. Heart J. 33 (2012) 3070–3077. [4] C. Zhou, L. Li, Age may contribute to the negative cardiac effect of postconditioning on STEMI patients, Int. J. Cardiol. 162 (2012) 59–60. [5] C. Zhou, H. Bulluck, N. Fang, L. Li, D.J. Hausenloy, Age and surgical complexity impact on renoprotection by remote ischemic preconditioning during adult cardiac surgery: a meta analysis, Sci. Rep. 7 (2017) 215.