Myocardial Injury
Conditions
Keywords
ischemia, myocardial infarction, prognosis, pretreatment, electroacupuncture, stents, troponin, percutaneous coronary intervention
Brief summary
Myocyte necrosis as a result of elective percutaneous coronary intervention (PCI) occurs in approximately one third of cases and is associated with subsequent cardiovascular events. This study assesses the ability of electroacupuncture (EA) pretreatment to attenuate cardiac troponin I (cTnI) release after elective PCI.
Detailed description
Elective percutaneous coronary intervention (PCI) is associated with troponin release in approximately one third of cases.Troponin release is a sensitive and specific marker of myocyte necrosis and infarction resulting from a form of ischemia/reperfusion injury, downstream embolization of atheromatous material, and coronary side-branch occlusion. A number of studies have demonstrated that procedure-related troponin release is associated with subsequent cardiovascular events. Transient sublethal episodes of ischemia before a prolonged ischemia/reperfusion injury, known as ischemic preconditioning (IPC), have been shown to reduce the extent of myocardial infarction (MI).Electroacupuncture (EA) stimulus, as a pretreatment method, limits MI size in animal models. However, there are limited outcome to demonstrate protection from EA pretreatment during PCI. The present study investigated the ability of EA pretreatment to attenuate cardiac troponin I (cTnI) release after elective PCI in a single-center, randomized controlled trial.
Interventions
PROCEDUREElectroacupuncture stimulation
According to the theory of traditional Chinese medicine, bilateral Neiguan (PC 6) acupoints were chosen and identified according to traditional anatomical localizations. Once insertion of original needles was made at the acupoints, the needle was stimulated electrically with the intensity of 2-6 mA and frequency of 2/30 Hz using the Electronic Acupuncture Treatment Instrument until the patient felt the so-called 'Teh Chi' sensation of heaviness, numbness and swelling. The pretreatment was individualized based on patients sex, age, weight and felt and given 1 time per day for 5 consecutive days before the heart valve replacement surgery．
PROCEDURENo intervention
The control patients were only placed needles at the bilateral Neiguan (PC 6)acupoints without electric stimulus.
Sponsors
Xijing Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* All patients \> 18 of age who are undergoing elective PCI and are able to give informed consent are eligible for study.
Exclusion criteria
* Emergency PCI, * Elevation of cTnI before PCI taken at the preadmission clinic, * Women of child-bearing age, * Nicorandil or glibenclamide use (preconditioning-mimetic and preconditioning blocking medication, respectively), and * Severe comorbidity (estimated life expectancy \< 6 months).
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The primary outcome was assessing whether EA pretreatment before elective PCI reduced cTnI concentration at 48 hours. | 48 hours after PCI |
Secondary
| Measure | Time frame |
|---|---|
| Secondary outcomes were the effect of EA pretreatment on ischemic symptoms, ECG evidence of ischemia during coronary balloon occlusion, CRP,and major adverse cardiac events (MACE) at 6 months. | six months of PCI follow-up. |
Countries
China
Outcome results
None listed