Response to Letter Regarding Article, ''Remote Ischemic Postconditioning During Percutaneous Coronary Interventions: Remote Ischemic Postconditioning-Percutaneous Coronary Intervention Randomized Trial'' Ronit Lavi, Sabrina D'Alfonso, Pantelis Diamantouros, Anthony Camuglia, Pallav Garg, Patrick Teefy, George Jablonsky, Kumar Sridhar and Shahar Lavi Circ Cardiovasc Interv. 2014;7:423 doi: 10.1161/CIRCINTERVENTIONS.114.001591 Circulation: Cardiovascular Interventions is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2014 American Heart Association, Inc. All rights reserved. Print ISSN: 1941-7640. Online ISSN: 1941-7632
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://circinterventions.ahajournals.org/content/7/3/423
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Correspondence Response to Letter Regarding Article, “Remote Ischemic Postconditioning During Percutaneous Coronary Interventions: Remote Ischemic Postconditioning-Percutaneous Coronary Intervention Randomized Trial” We thank Drs Giblett and Hoole1 for their interest in our article.2 The rationale for assessing the value of ischemic postconditioning as opposed to preconditioning during percutaneous coronary intervention is lengthily reviewed in our article. The failure of ischemic postconditioning may have been related to its late application.2 It is possible that applying ischemic conditioning immediately after the diagnostic angiography would have resulted in a different outcome. Indeed, such an intervention would avoid the discomfort associated with preconditioning in patients who subsequently do not receive percutaneous coronary intervention. However, such method would still require intervening on all patients undergoing percutaneous coronary intervention, instead of identifying the patients who may benefit from this intervention. One of the objectives of our study was to apply ischemic conditioning after stenting, as a model for postconditioning in ST-segment–elevation myocardial infarction. Ultimately, the ST-segment–elevation myocardial infarction population is more likely to benefit from any intervention that improves myocardial protection, but to date, the results of the ST-segment–elevation myocardial infarction trials are not consistent.3,4 Many patients who present with ST-segment–elevation myocardial infarction have antecedent angina. With regard to the potential higher threshold in some of the patients, one of our objectives was to apply a higher magnitude of ischemia by inflating the blood pressure cuff on the thigh. Whether overcoming a higher threshold is better achieved by applying more cycles or longer cycles remains to be defined.5 Ischemic conditioning may indeed be a valuable therapeutic modality, but further studies are needed before its translation to clinical practice.
Disclosures None. Ronit Lavi, MD Sabrina D’Alfonso, MSc Pantelis Diamantouros, MD Anthony Camuglia, MD Pallav Garg, MD Patrick Teefy, MD George Jablonsky, MD Kumar Sridhar, MD Shahar Lavi, MD Western University London Health Sciences Centre London, Ontario, Canada
References 1. Giblett JP, Hoole SP. Letter by Giblett and Hoole regarding article, “Remote ischemic postconditioning during percutaneous coronary interventions: remote ischemic postconditioning-percutaneous coronary intervention randomized trial.” Circ Cardiovasc Interv. 2014;7:422. 2. Lavi S, D’Alfonso S, Diamantouros P, Camuglia A, Garg P, Teefy P, Jablonsky G, Sridhar K, Lavi R. Remote ischemic postconditioning during percutaneous coronary interventions: remote ischemic postconditioning-percutaneous coronary intervention randomized trial. Circ Cardiovasc Interv. 2014;7:225–232. 3. Staat P, Rioufol G, Piot C, Cottin Y, Cung TT, L’Huillier I, Aupetit JF, Bonnefoy E, Finet G, André-Fouët X, Ovize M. Postconditioning the human heart. Circulation. 2005;112:2143–2148. 4. Hahn JY, Song YB, Kim EK, Yu CW, Bae JW, Chung WY, Choi SH, Choi JH, Bae JH, An KJ, Park JS, Oh JH, Kim SW, Hwang JY, Ryu JK, Park HS, Lim DS, Gwon HC. Ischemic postconditioning during primary percutaneous coronary intervention: the effects of postconditioning on myocardial reperfusion in patients with ST-segment elevation myocardial infarction (POST) randomized trial. Circulation. 2013;128:1889–1896. 5. Lavi S, Lavi R. Conditioning of the heart: from pharmacological interventions to local and remote protection: possible implications for clinical practice. Int J Cardiol. 2011;146:311–318.
(Circ Cardiovasc Interv. 2014;7:423.) © 2014 American Heart Association, Inc. Circ Cardiovasc Interv is available at http://circinterventions.ahajournals.org
DOI: 10.1161/CIRCINTERVENTIONS.114.001591
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The online version of this article, along with updated information and services, is located on the World Wide Web at: http://circinterventions.ahajournals.org/content/7/3/423
Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Circulation: Cardiovascular Interventions can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Circulation: Cardiovascular Interventions is online at: http://circinterventions.ahajournals.org//subscriptions/
Downloaded from http://circinterventions.ahajournals.org/ by guest on July 9, 2014
Correspondence Response to Letter Regarding Article, “Remote Ischemic Postconditioning During Percutaneous Coronary Interventions: Remote Ischemic Postconditioning-Percutaneous Coronary Intervention Randomized Trial” We thank Drs Giblett and Hoole1 for their interest in our article.2 The rationale for assessing the value of ischemic postconditioning as opposed to preconditioning during percutaneous coronary intervention is lengthily reviewed in our article. The failure of ischemic postconditioning may have been related to its late application.2 It is possible that applying ischemic conditioning immediately after the diagnostic angiography would have resulted in a different outcome. Indeed, such an intervention would avoid the discomfort associated with preconditioning in patients who subsequently do not receive percutaneous coronary intervention. However, such method would still require intervening on all patients undergoing percutaneous coronary intervention, instead of identifying the patients who may benefit from this intervention. One of the objectives of our study was to apply ischemic conditioning after stenting, as a model for postconditioning in ST-segment–elevation myocardial infarction. Ultimately, the ST-segment–elevation myocardial infarction population is more likely to benefit from any intervention that improves myocardial protection, but to date, the results of the ST-segment–elevation myocardial infarction trials are not consistent.3,4 Many patients who present with ST-segment–elevation myocardial infarction have antecedent angina. With regard to the potential higher threshold in some of the patients, one of our objectives was to apply a higher magnitude of ischemia by inflating the blood pressure cuff on the thigh. Whether overcoming a higher threshold is better achieved by applying more cycles or longer cycles remains to be defined.5 Ischemic conditioning may indeed be a valuable therapeutic modality, but further studies are needed before its translation to clinical practice.
Disclosures None. Ronit Lavi, MD Sabrina D’Alfonso, MSc Pantelis Diamantouros, MD Anthony Camuglia, MD Pallav Garg, MD Patrick Teefy, MD George Jablonsky, MD Kumar Sridhar, MD Shahar Lavi, MD Western University London Health Sciences Centre London, Ontario, Canada
References 1. Giblett JP, Hoole SP. Letter by Giblett and Hoole regarding article, “Remote ischemic postconditioning during percutaneous coronary interventions: remote ischemic postconditioning-percutaneous coronary intervention randomized trial.” Circ Cardiovasc Interv. 2014;7:422. 2. Lavi S, D’Alfonso S, Diamantouros P, Camuglia A, Garg P, Teefy P, Jablonsky G, Sridhar K, Lavi R. Remote ischemic postconditioning during percutaneous coronary interventions: remote ischemic postconditioning-percutaneous coronary intervention randomized trial. Circ Cardiovasc Interv. 2014;7:225–232. 3. Staat P, Rioufol G, Piot C, Cottin Y, Cung TT, L’Huillier I, Aupetit JF, Bonnefoy E, Finet G, André-Fouët X, Ovize M. Postconditioning the human heart. Circulation. 2005;112:2143–2148. 4. Hahn JY, Song YB, Kim EK, Yu CW, Bae JW, Chung WY, Choi SH, Choi JH, Bae JH, An KJ, Park JS, Oh JH, Kim SW, Hwang JY, Ryu JK, Park HS, Lim DS, Gwon HC. Ischemic postconditioning during primary percutaneous coronary intervention: the effects of postconditioning on myocardial reperfusion in patients with ST-segment elevation myocardial infarction (POST) randomized trial. Circulation. 2013;128:1889–1896. 5. Lavi S, Lavi R. Conditioning of the heart: from pharmacological interventions to local and remote protection: possible implications for clinical practice. Int J Cardiol. 2011;146:311–318.
(Circ Cardiovasc Interv. 2014;7:423.) © 2014 American Heart Association, Inc. Circ Cardiovasc Interv is available at http://circinterventions.ahajournals.org
DOI: 10.1161/CIRCINTERVENTIONS.114.001591
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