Remote ischemic preconditioning reduces contrast-induced acute kidney injury in patients with ST-elevation myocardial infarction: A randomized controlled trial

Toshiaki Yamanaka, Yusuke Kawai, Toru Miyoshi, Tsutomu Mima, Kenji Takagaki, Saori Tsukuda, Yukio Kazatani, Kazufumi Nakamura, Hiroshi Itoh

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Abstract

Background Contrast medium-induced acute kidney injury (CI-AKI) is a cardiovascular complication after myocardial infarction treated with emergency percutaneous coronary intervention. The aim of this randomized, sham-controlled trial was to evaluate the impact of remote ischemic preconditioning (RIPC) on CI-AKI in patients with ST-elevation myocardial infarction who received emergency primary percutaneous coronary intervention.

Methods and results Patients with a suspected ST-elevation myocardial infarction were randomly assigned at a 1:1 ratio to receive percutaneous coronary intervention either with (n = 63) or without (n = 62) RIPC (intermittent arm ischemia through three cycles of 5 min of inflation and 5 min of deflation of a blood pressure cuff). A total of 47 RIPC patients and 47 control patients met all study criteria. The primary endpoint was the incidence of CI-AKI, which was defined as an increase in serum creatinine > 0.5 mg/dL or > 25% over the baseline value 48-72 h after administration of contrast medium. The incidence of CI-AKI was 10% (n = 5) in the RIPC group and 36% (n = 17) in the control group (p = 0.003). The odds ratio of CI-AKI in patients who received RIPC was 0.18 (95% confidence interval: 0.05-0.64; p = 0.008).

Conclusions In patients with ST-elevation myocardial infarction, RIPC before percutaneous coronary intervention reduced the incidence of CI-AKI.

Original languageEnglish
Pages (from-to)136-141
Number of pages6
JournalInternational Journal of Cardiology
Volume178
DOIs
Publication statusPublished - Jan 15 2015

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Ischemic Preconditioning
Acute Kidney Injury
Contrast Media
Randomized Controlled Trials
Percutaneous Coronary Intervention
Incidence
Emergencies
Economic Inflation
ST Elevation Myocardial Infarction
Creatinine
Ischemia
Odds Ratio
Myocardial Infarction
Confidence Intervals
Blood Pressure
Control Groups
Serum

Keywords

  • Contrast media
  • Myocardial infarction
  • Percutaneous coronary intervention
  • Renal failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Remote ischemic preconditioning reduces contrast-induced acute kidney injury in patients with ST-elevation myocardial infarction : A randomized controlled trial. / Yamanaka, Toshiaki; Kawai, Yusuke; Miyoshi, Toru; Mima, Tsutomu; Takagaki, Kenji; Tsukuda, Saori; Kazatani, Yukio; Nakamura, Kazufumi; Itoh, Hiroshi.

In: International Journal of Cardiology, Vol. 178, 15.01.2015, p. 136-141.

Research output: Contribution to journalArticle

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abstract = "Background Contrast medium-induced acute kidney injury (CI-AKI) is a cardiovascular complication after myocardial infarction treated with emergency percutaneous coronary intervention. The aim of this randomized, sham-controlled trial was to evaluate the impact of remote ischemic preconditioning (RIPC) on CI-AKI in patients with ST-elevation myocardial infarction who received emergency primary percutaneous coronary intervention.Methods and results Patients with a suspected ST-elevation myocardial infarction were randomly assigned at a 1:1 ratio to receive percutaneous coronary intervention either with (n = 63) or without (n = 62) RIPC (intermittent arm ischemia through three cycles of 5 min of inflation and 5 min of deflation of a blood pressure cuff). A total of 47 RIPC patients and 47 control patients met all study criteria. The primary endpoint was the incidence of CI-AKI, which was defined as an increase in serum creatinine > 0.5 mg/dL or > 25{\%} over the baseline value 48-72 h after administration of contrast medium. The incidence of CI-AKI was 10{\%} (n = 5) in the RIPC group and 36{\%} (n = 17) in the control group (p = 0.003). The odds ratio of CI-AKI in patients who received RIPC was 0.18 (95{\%} confidence interval: 0.05-0.64; p = 0.008).Conclusions In patients with ST-elevation myocardial infarction, RIPC before percutaneous coronary intervention reduced the incidence of CI-AKI.",
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AU - Mima, Tsutomu

AU - Takagaki, Kenji

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AU - Kazatani, Yukio

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N2 - Background Contrast medium-induced acute kidney injury (CI-AKI) is a cardiovascular complication after myocardial infarction treated with emergency percutaneous coronary intervention. The aim of this randomized, sham-controlled trial was to evaluate the impact of remote ischemic preconditioning (RIPC) on CI-AKI in patients with ST-elevation myocardial infarction who received emergency primary percutaneous coronary intervention.Methods and results Patients with a suspected ST-elevation myocardial infarction were randomly assigned at a 1:1 ratio to receive percutaneous coronary intervention either with (n = 63) or without (n = 62) RIPC (intermittent arm ischemia through three cycles of 5 min of inflation and 5 min of deflation of a blood pressure cuff). A total of 47 RIPC patients and 47 control patients met all study criteria. The primary endpoint was the incidence of CI-AKI, which was defined as an increase in serum creatinine > 0.5 mg/dL or > 25% over the baseline value 48-72 h after administration of contrast medium. The incidence of CI-AKI was 10% (n = 5) in the RIPC group and 36% (n = 17) in the control group (p = 0.003). The odds ratio of CI-AKI in patients who received RIPC was 0.18 (95% confidence interval: 0.05-0.64; p = 0.008).Conclusions In patients with ST-elevation myocardial infarction, RIPC before percutaneous coronary intervention reduced the incidence of CI-AKI.

AB - Background Contrast medium-induced acute kidney injury (CI-AKI) is a cardiovascular complication after myocardial infarction treated with emergency percutaneous coronary intervention. The aim of this randomized, sham-controlled trial was to evaluate the impact of remote ischemic preconditioning (RIPC) on CI-AKI in patients with ST-elevation myocardial infarction who received emergency primary percutaneous coronary intervention.Methods and results Patients with a suspected ST-elevation myocardial infarction were randomly assigned at a 1:1 ratio to receive percutaneous coronary intervention either with (n = 63) or without (n = 62) RIPC (intermittent arm ischemia through three cycles of 5 min of inflation and 5 min of deflation of a blood pressure cuff). A total of 47 RIPC patients and 47 control patients met all study criteria. The primary endpoint was the incidence of CI-AKI, which was defined as an increase in serum creatinine > 0.5 mg/dL or > 25% over the baseline value 48-72 h after administration of contrast medium. The incidence of CI-AKI was 10% (n = 5) in the RIPC group and 36% (n = 17) in the control group (p = 0.003). The odds ratio of CI-AKI in patients who received RIPC was 0.18 (95% confidence interval: 0.05-0.64; p = 0.008).Conclusions In patients with ST-elevation myocardial infarction, RIPC before percutaneous coronary intervention reduced the incidence of CI-AKI.

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