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Remote Myocardial Ischemic Preconditioning in Humans (RemoteMIPH)

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ClinicalTrials.gov Identifier: NCT00588042
Recruitment Status : Completed
First Posted : January 8, 2008
Last Update Posted : June 4, 2014
Sponsor:
Information provided by (Responsible Party):
Abhiram Prasad, Mayo Clinic

Brief Summary:
Ischemic preconditioning (IP) has been shown in animal studies to increase the myocardial tolerance to subsequent ischemia. Our primary hypothesis is that remote IP reduces myocardial ischemic injury during PCI.

Condition or disease Intervention/treatment Phase
Coronary Artery Ischemia Device: Blood pressure cuff Device: blood pressure cuff Not Applicable

Detailed Description:

Our primary hypothesis is that remote IP reduces myocardial ischemic injury during PCI. We will also test the hypotheses that IP diminishes the inflammatory response to PCI, and that higher baseline blood endothelial progenitor cell counts are predictive of a favorable response to IP.

Aim 1: To evaluate whether remote ischemic preconditioning reduces the frequency of myonecrosis (troponin T≥0.03 ng/ml following PCI).

Aim 2: To evaluate whether remote ischemic preconditioning reduces the inflammatory response to PCI (post PCI hsCRP level).

Aim 3: To evaluate whether pre-procedure circulating endothelial progenitor cell counts correlate with the effect of remote ischemic preconditioning on myonecrosis.

Background: Percutaneous coronary intervention (PCI) frequently results in ischemic myonecrosis. Ischemic preconditioning (IP) has been shown in animal studies to increase the myocardial tolerance to subsequent ischemia. Our primary hypothesis is that remote IP reduces myocardial ischemic injury during PCI.

Aims: The aims of the study are to assess in patients with coronary artery disease requiring PCI, whether remote IP reduces: 1) the frequency of myonecrosis; and 2) the inflammatory response to PCI; and 3) whether the effect of IP correlates with pre-procedure circulating endothelial progenitor cell counts.

Methods: The study is a prospective, randomized trial to assess the efficacy of remote IP as adjunctive non-pharmacological therapy for PCI in patients with stable or unstable angina. Remote IP will be performed by 3 cycles of 3-minutes of arm ischemia alternating with 3- minutes of reperfusion of the arm immediately before PCI. Myonecrosis and inflammation will be detected by measuring serum troponin T and high sensitivity C-reactive protein, respectively. Blood EPC counts will also be measured before the procedure.


Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 156 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Investigator)
Primary Purpose: Treatment
Official Title: Remote Myocardial Ischemic Preconditioning in Humans
Study Start Date : October 2007
Actual Primary Completion Date : June 2009
Actual Study Completion Date : June 2009

Arm Intervention/treatment
Active Comparator: 1
Arm ischemia will be induced using a blood pressure cuff that will be placed around the upper part of the arm, and inflated to 200 mm Hg for 3-minutes and then deflated for 3-minutes
Device: Blood pressure cuff
Arm ischemia will be induced using a blood pressure cuff that will be placed around the upper part of the arm, and inflated to 200 mm Hg for 3-minutes and then deflated for 3-minutes
Other Name: sphygmomanometer
Sham Comparator: 2
3-cycles of cuff inflation (10 mmHg)-deflation will also be performed in the control group for similar durations without inducing ischemia
Device: blood pressure cuff
3-cycles of cuff inflation (10 mmHg)-deflation will also be performed in the control group for similar durations without inducing ischemia
Other Name: sphygmomanometer



Primary Outcome Measures :
  1. Post PCI myonecrosis measured as a maximum troponin T ≥0.03 [ Time Frame: 16 hours post PCI ]

Secondary Outcome Measures :
  1. Post PCI myonecrosis measured as an elevation in creatine kinase MB fraction (CK-MB> 1 X upper limit of normal) [ Time Frame: 16 hours post procedure ]
  2. Magnitude of ST segment elevation on an intracoronary electrocardiogram during balloon inflation [ Time Frame: During PCI procedure ]
  3. Coronary perfusion measured as coronary flow reserve derived from TIMI frame counts [ Time Frame: During PCI ]
  4. Blood high sensitivity C-reactive protein level [ Time Frame: Immediately prePCI ]
  5. Blood endothelial progenitor cell counts (EPC) [ Time Frame: Immediately prePCI ]


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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients will be eligible for randomization if they meet the following criteria:

    1. Age ≥ 18 years
    2. Clinically indicated elective or urgent PCI

Exclusion Criteria:

  • Patients will be ineligible for the study if one or more of the following conditions exist:

    1. Pre-PCI Troponin T ≥ 0.03
    2. Systemic hypotension (systolic <90 mmHg) or cardiogenic shock
    3. Presence of an arteriovenous fistula or lymphedema of either arm
    4. Currently enrolled in other active cardiovascular investigational studies
    5. Severe endocrine, hepatic, renal, disorders
    6. Pregnancy or lactation
    7. Inability to provide consent
    8. Federal Medical Center inmates
    9. Inability or unwillingness to provide informed consent

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00588042


Locations
United States, Minnesota
Mayo Clinic
Rochester, Minnesota, United States, 55905
Sponsors and Collaborators
Mayo Clinic
Investigators
Principal Investigator: Abhiram Prasad, MBBS Mayo Clinic

Additional Information:
Publications of Results:
Responsible Party: Abhiram Prasad, Professor of Medicine, Mayo Clinic
ClinicalTrials.gov Identifier: NCT00588042     History of Changes
Other Study ID Numbers: 06-005081
Remote MIPH
First Posted: January 8, 2008    Key Record Dates
Last Update Posted: June 4, 2014
Last Verified: June 2014

Keywords provided by Abhiram Prasad, Mayo Clinic:
Angioplasty, Transluminal, Percutaneous Coronary
Coronary Artery Disease
Coronary Occlusion

Additional relevant MeSH terms:
Ischemia
Pathologic Processes