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Circadian rhythm impact in remote ischemic conditioning in myocardial infarction
Session:
Comunicações Orais (Sessão 6) - DAC e Cuidados Intensivos 2 - Vários Tópicos
Speaker:
Carla Marques Pires
Congress:
CPC 2022
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.1 Acute Coronary Syndromes – Pathophysiology and Mechanisms
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Carla Marques Pires; Diana Lamas; António Gaspar; Nuno Antunes; Jorge Marques; Adelino f. Leite-Moreira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:NewsGotT"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">Introduction:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif"> Remote ischemic conditioning (RIC) as an adjuvant to primary percutaneous coronary intervention (PPCI) have been promising in ischemia–reperfusion injury (IRI) reduction in ST-elevation myocardial infarction (STEMI) patients. However, there are some controversial results regarding the improvement of clinical outcomes. Daytime variation seems to affect the tolerance of cardiomyocyte to IRI, and consequently, recovery of contraction and clinical outcomes.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:NewsGotT"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">AIM:</span></span></strong> <span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">To assess the daytime variation impact on clinical outcomes of RIC as an adjuvant to PPCI in STEMI patients.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:NewsGotT"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">METHODS: </span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:NewsGotT"><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">A post-hoc analysis of a prospective, single-center, open-label, randomized controlled trial was performed.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:NewsGotT"><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">This analysis included 448 STEMI patients, randomized in 2 groups: PPCI alone (n=217) and RIC as an adjuvant to PPCI (n=231). The sample was, additionally, divided according to the time of the PPCI: night-morning (22:00-11:59) (n = 216) and afternoon (12:00-21:59) (n=232) periods.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:NewsGotT"><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">Clinical characteristics and follow-up clinical outcomes were analyzed and compared between groups. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:NewsGotT"><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">The factors that contribute to our primary follow-up endpoint (cardiac death and hospitalization due to heart failure) were identified through a survival analysis.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:NewsGotT"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">Results:</span></span></strong> </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:NewsGotT"><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">There were no significant differences in clinical characteristics and follow-up clinical outcomes between both periods of the day.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:NewsGotT"><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">Afternoon period (HR=0.474; p=0.043) and RIC (HR=0.423; p=0.029) were independent predictors of primary follow-up endpoint.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:NewsGotT"><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">Univariate analysis showed a lower frequency of primary follow-up endpoint in RIC group compared to alone PPCI group just in the afternoon period (10,3%vs0,9%; p=0.002).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:NewsGotT"><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">For these reason, a multivariate analysis was performed and revealed that RIC is an independent predictor of primary follow-up endpoint in the afternoon group ((HR=0.98; p=0.029), but not in the night-morning group.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:NewsGotT"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">Conclusion:</span></span></strong> </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:NewsGotT"><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">Previous published literature already suggested that the impact of RIC could be restricted to a subgroup of higher risk patients.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:NewsGotT"><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">This study proposes that afternoon period improves cardioprotection induced by RIC. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:NewsGotT"><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">However, further studies with larger samples are needed to explore this topic.</span></span></span></span></p> <p style="text-align:justify"> </p>
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