The magic of remote ischaemic preconditioning

the magic of remote

ischaemic preconditionin

g

Slide on regionaltwo waysto give a

dog a heart attack

block coronary artery

unblock coronary artery

measure size of infarct

block coronary artery

unblock coronary artery

measure size of infarct

Ischaemia / reperfusion

cycles

Method B gives the

dog a smaller heart attack

Warm-up anginaPre-infarct angina

Cross clamp fibrillation

remote ischaemic

preconditioning

Early work

Transient renal ischaemia protects the heart!

The breakthrough

ReproducibleNo one knows how it works

Fundamental unknowns

1.Where?

2.How?3.When?4.Who?

RIPC Nearly 1000

papers

My Trial

Patients allocated to RIPC had higher

troponin levels

Meta-analysis

High impact trials

2 NEJM papers

A JAMA paper

A Lancet paper

1. What the patient can do 2. How the patient feels3. Whether the patient is alive4. Does it save money

all that

matters

be sceptical; changes in

secondary end points are hypothesis generating

Ischaemia

reperfusion

+

remote reperfusion injury preconditioning

1.Heart surgery 2.PCI3.CVA with thrombolysis or clot

retrieval4.Vascular surgery5.Hypoxic ischaemic

encephalopathy6.Organ transplantation

STEMI

1. Don’t believe single-centre studies

2. Always think about biological plausibility3. Treat findings in secondary endpoints as

hypothesis generating

4. Don’t be misled by surrogate endpoints

@DogICUma

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