Event-free survival of patients with acute myocardial infarction during 36 months after PPCI in combination with combined protocol of distant ischemic conditioning as a method of cardio protection

Background. Reperfusion injury occurs after revascularization of the coronary artery in patients with myocardial infarction (MI) significantly contributing to the development of chronic heart failure. This article describes the results of studying the effectiveness of one of the promising cardioprotection strategies aimed at limiting reperfusion injury.
Materials and methods. Patients with acute anterior MI with ST elevation (STEMI) (n = 87) were included in an open-label prospective randomized controlled trial. Intervention group (IG) patients underwent primary percutaneous coronary intervention (PPCI) and remote ischemic preconditioning in combination with delayed postconditioning (RIPerPostC) (n = 43). Control group patients (CG) underwent only standard PPCI (n = 44). Event-free survival was estimated by Kaplan-Meier curves.
Results. A comparative analysis of the frequency of the composite endpoint (re-hospitalizations for the underlying disease, repeated MI and death from cardiac causes) by the 36th month of follow-up had shown that the proportion of patients who reached the endpoint was significantly higher in the CG: 45.5% vs 20.9% in the IG (p = 0.015). According to the results of the log-rank test, there are statistically significant differences in the event-free survival of the analyzed groups (LR = 1.99, p = 0.047). The Kaplan-Meier curves of the CG and IG during the first 12 months after AMI did not differ visually in height and slope, which indicated the absence of intergroup differences in the cumulative functions of event-free survival during the indicated observation period. After 12 months, there was a discrepancy between the Kaplan-Meier curves due to the fact that the survival rate continued to decrease rapidly only in the CG. According to the survival function, in 25% of CG patients, adverse events occurred within the first 13 months after AMI. Taking into account censored observations, the cumulative proportion of patients without major clinical events 36 months after AMI in the IG was 74% versus 38% in the CG.
Conclusion. In patients with STEMI the DIPerPostC method in combination with PPCI has a positive effect on patient survival over 36 months in comparison with isolated PPCI. The highest number of adverse events occurred during the period from 12 to 36 months of observation in the CG.

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