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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
