Impact of peripheral conditioning on reperfusion injury following primary percutaneous coronary intervention in diabetic and non-diabetic STEMI patients.

Abstract

Background: Peripheral conditioning induces transient ischemia, promoting antioxidant production in ischemia-affected tissues, which helps reduce heart reperfusion injury in ST-elevation myocardial infarction (STEMI) patients. This study compares troponin and creatine kinase-MB (CK-MB) levels among STEMI patients with and without remote conditioning.

Methods: This study included 160 patients treated for STEMI at a tertiary care centre. The study protocol involved cyclic inflation and deflation of a blood pressure cuff on the brachial region in four cycles of 5 min each. Markers of myocardial necrosis, CK-MB, and troponin, were monitored before percutaneous coronary intervention (PCI), immediately after, and at 24, 48, and 72 h post-PCI.

Results: CK-MB and troponin levels were significantly lower in non-diabetic patients who underwent remote peripheral conditioning compared to those who did not, with significant reductions observed after PCI (CK-MB: p = 0.001; troponin: p = 0.033), and at 24 (CK-MB: p = 0.015; troponin: p = 0.001) and 48 h post-PCI (troponin: p = 0.002). In the second phase, no significant differences in CK-MB or troponin levels were found between diabetic patients with and without conditioning. However, a trend toward lower values was noted in the conditioned group. In the third phase, significant reductions in CK-MB (p = 0.002) and troponin levels (after PCI: p = 0.007; 24 h post-PCI: p = 0.045) were observed across all patients who underwent conditioning compared to the control group.

Conclusion: Peripheral pre- and post-conditioning is an economical, simple, and physiological method that effectively prevents and reduces heart damage caused by reperfusion injury, particularly in non-diabetic STEMI patients.