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Effect of comprehensive remote ischemic conditioning in anterior ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: Design and rationale of the CORIC-MI randomized trial.

ABSTRACT: Remote ischemic conditioning (RIC) applied during or after ST-segment elevation myocardial infarction (STEMI) is currently the most promising adjuvant therapy to reduce reperfusion injury. Recent animal studies showed that RIC may help the myocardium recover if applied daily during the month after STEMI. The Comprehensive Remote Ischemic Conditioning in Myocardial Infarction (CORIC-MI) trial is a single-center randomized controlled study in which 200 patients undergoing primary percutaneous coronary intervention (PPCI) for anterior STEMI will be randomized in a 1:1 ratio into comprehensive RIC (CORIC) or no intervention (control) groups. CORIC consists of per-RIC (5 cycles of 5-minute ischemia and 5-minute reperfusion of the lower limb immediately after randomization and before reperfusion), post-RIC (5 cycles of 5-minute ischemia and 5-minute reperfusion of the lower limb immediately post-PPCI), and delayed RIC (5 cycles of 5-minute ischemia and 5-minute reperfusion of the lower limb once daily on 2-28 days). Primary endpoint is left ventricular ejection fraction assessed by cardiac magnetic resonance imaging at 30 days. Major secondary endpoints include infarct size and left ventricular volume assessed by cardiac magnetic resonance imaging at 30 days, left ventricular ejection fraction assessed by echocardiography, and major adverse cardiovascular events up to 12 months. This report presents the baseline characteristics of 93 patients (CORIC group, n = 49; control group, n = 44) enrolled into the study as of March 31, 2018. The CORIC-MI trial aims to test the hypothesis that CORIC will improve cardiac function and remodeling in patients with anterior STEMI undergoing PPCI.

SUBMITTER: Song L

PROVIDER: S-EPMC6489915 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Effect of comprehensive remote ischemic conditioning in anterior ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: Design and rationale of the CORIC-MI randomized trial.

Song Li L Yan Hongbing H Yan Hongbing H Zhou Peng P Zhao Hanjun H Liu Chen C Sheng Zhaoxue Z Tan Yu Y Yi Chen C Li Jiannan J Zhou Jinying J

Clinical cardiology 20180816 8

Remote ischemic conditioning (RIC) applied during or after ST-segment elevation myocardial infarction (STEMI) is currently the most promising adjuvant therapy to reduce reperfusion injury. Recent animal studies showed that RIC may help the myocardium recover if applied daily during the month after STEMI. The Comprehensive Remote Ischemic Conditioning in Myocardial Infarction (CORIC-MI) trial is a single-center randomized controlled study in which 200 patients undergoing primary percutaneous coro ...[more]

PMID: 29726013

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Project description:BackgroundOver the past 20 years, the development of regional ST-elevation myocardial infarction (STEMI) care systems has led to remarkable progress in achieving timely coronary reperfusion with attendant improvement in clinical outcomes, including survival. Despite this progress, contemporary STEMI care does not consistently meet the national guideline-recommended goals, which offers an opportunity for further improvement in STEMI outcomes. The lack of single, comprehensive, national STEMI registry complicates our ability to improve STEMI outcomes in particular for high-risk STEMI subsets such as cardiac arrest (CA) and/or cardiogenic shock (CS).ObjectivesTo address this need, the Midwest STEMI Consortium (MSC) was created as a collaboration of 4 large, regional STEMI care systems to provide a comprehensive, multicenter, and prospective STEMI registry without any exclusionary criteria.MethodsThe MSC is a collaboration of 4 large, regional STEMI care systems: Iowa Heart Center in Des Moines, IA; Minneapolis Heart Institute Foundation in Minneapolis, MN; Prairie Heart Institute in Springfield, IL; and The Christ Hospital in Cincinnati, OH. Each has similar standardized STEMI protocol and together include 6 percutaneous coronary intervention (PCI)-capable hospitals and over 100 non-PCI-capable hospitals. Each center had a prospective database that was transferred to a data coordinating center to create the multicenter database. The comprehensive database includes traditional risk factors, cardiovascular history, medications, time to treatment data, detailed angiographic characteristics, and short- and long-term clinical outcomes up to 5-year for myocardial infarction, stroke, and cardiovascular and all-cause mortality. Ten-year mortality rates were assessed by using national death index.ResultsCurrently, the comprehensive database (03/2003-01/2020) includes 14,911 consecutive STEMI patients with mean age of 62.3 ± 13.6 years, female gender (29%), and left anterior descending artery as the culprit vessel (34%). High risk features included: Age >75 years (19%), left ventricular ejection fraction <35% (15%), CA (10%), and CS (8%).ConclusionThis collaboration of 4 large, regional STEMI care systems with broad entry criteria including high-risk STEMI subsets such as CA and/or CS provides a unique platform to conduct clinical research studies to optimize STEMI care.

Project description:Low level of testosterone may be associated with cardiovascular diseases in men, as some evidence suggests a protective role for testosterone in cardiovascular system. Little is known about the possible role of serum testosterone in response to reperfusion therapy in ST-elevation myocardial infarction (STEMI) and its relationship with ST-segment recovery. The present study was conducted to evaluate the association of serum testosterone levels with ST-segment resolution following primary percutaneous coronary intervention (PPCI) in male patients with acute STEMI.Forty-eight men (mean age 54.55 ± 12.20) with STEMI undergoing PPCI were enrolled prospectively. Single-lead ST segment resolution in the lead with maximum baseline ST-elevation was measured and patients were divided into two groups according to the degree of ST-segment resolution: complete (> or =50%) or incomplete (<50%). The basic and demographic data of all patients, their left ventricular ejection fraction (LVEF) and laboratory findings including serum levels of free testosterone and cardiac enzymes were recorded along with angiographic finding and baseline TIMI (Thrombolysis in Myocardial Infarction) flow and also in-hospital complications and then these variables were compared between two groups.A complete ST-resolution (≥50%) was observed in 72.9% of the patients. The serum levels of free testosterone (P = 0.04), peak cardiac troponin (P = 0.03) were significantly higher and hs-CRP (P = 0.02) were lower in patients with complete ST-resolution compared to those with incomplete ST-resolution. In-hospital complications were observed in 31.2% of patients. The patients with a lower baseline TIMI flow (P = 0.03) and those who developed complications (P = 0.04) had lower levels of free testosterone. A significant positive correlation was observed between the left ventricular function and serum levels of free testosterone (P = 0.01 and r = +0.362).This study suggests that in men with STEMI undergoing PPCI, higher serum levels of testosterone are associated with a better reperfusion response, fewer complications and a better left ventricular function.

Dataset Information

Effect of comprehensive remote ischemic conditioning in anterior ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: Design and rationale of the CORIC-MI randomized trial.

Publications

Effect of comprehensive remote ischemic conditioning in anterior ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: Design and rationale of the CORIC-MI randomized trial.

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