SLIDE 1
Gibbons et al. JACC 2004;44:1533-1542
Le Remote Conditioning Pourquoi sen priver? Pr Fabrice Prunier - - PowerPoint PPT Presentation
Le Remote Conditioning Pourquoi sen priver? Pr Fabrice Prunier - - PowerPoint PPT Presentation
Le Remote Conditioning Pourquoi sen priver? Pr Fabrice Prunier EA 3860 Cardioprotection, Remodelage et Thrombose & Service de Cardiologie, CHU d Angers, France Rseau INSERM RIRE : Rseau Infarctus de REperfusion
SLIDE 2
SLIDE 3
L’infarctus de reperfusion
SLIDE 4
- Anesthetized dogs
- Remote intraorgan preconditioning
- 4 episodes of 5min LCX occlusion
interspersed with 5min reperfusion before 1h LAD occlusion
- 35% reduction of infarct size (similar range
than direct LAD preconditioning) Remote Preconditioning
Przyklenk et al. Circulation 1993;87:893-99
SLIDE 5
Remote Perconditioning
Kerendi et al. Basic Res Cardiol 2005;100:404-12
rats
SLIDE 6
Hausenloy and Yellon. Cardiovasc Res 2008
Remote conditioning
SLIDE 7
- G. Heusch Lancet 2013;381:166-75
Remote Ischemic Conditioning in Human
SLIDE 8
Patient Recruitment and Randomization
Ambulance Patient
ECG
Randomization Bøtker et al. ACC 2009
4x 5/5 200 mmHg
SLIDE 9
Primary Endpoint: Myocardial Salvage Index
Acute scan: Area-at-risk (AAR)
Salvage index = (AAR-FIS)/AAR
One month scan: Final infarct size (FIS) Bøtker et al. ACC meeting 2009
SLIDE 10
.5 1
Primary Endpoint: Myocardial Salvage Index
p=0.02
Salvage Index (median [IQR])
PCI only rIPerC
0.56 0.76 Bøtker et al. ACC meeting 2009
SLIDE 11
RIPOST-MI (Remote Ischemic POSTconditioning in Myocardial Infarction)
SCA ST+ <6h
Randomisation
RIPer Objectif principal: Taille de la nécrose sur cinétique CPK-MB Biocollection Traitement conventionnel RIPer + IPost
RIPer = 3 X 5/5min RIPer = 3 X 5/5min IPost = 4 X 1/1 min Dotation SFC/FFC 2011 (80 000€) Réseau INSERM RIRE Prunier et al. Unpublished data
SLIDE 12
RIPOST-MI study
Dotation SFC/FFC 2011 Réseau INSERM RIRE
Brest& Tours& Montpellier& Angers& Toulouse&
PHRC 2011
Lyon&
Prunier et al. Unpublished data
SLIDE 13
Prunier et al. Unpublished data
SLIDE 14
- Facile à faire
- Sans effet secondaire
- Sous surcoût
- Intérêt potentiel pour infarctus, AVC, chirurgie
cardiaque, transplantation… Mais…
- Absence de donnée sur des critères durs dans de
larges études de morbi-mortalité
- Mécanisme incomplètement compris
Alors pourquoi s’en priver?
SLIDE 15
CONCLUSION
New perspective in reperfusion: cardioprotection with a conditioning approach
Remote conditioning
SLIDE 16
SLIDE 17
Back-up slides
SLIDE 18
Remote conditioning
Kharbanda et al. Lancet 2009
SLIDE 19
Apolipoprotéine A-I : un médiateur du conditionnement à distance
Hibert et al. PlosOne 2013
SLIDE 20
151#randomized#pa.ents#with#STEMI# 44#assigned#to#Control#group# 71#assigned#to#Riper+IPost#group#
24#excluded#because#did#not# meet#study#criteria# ####12#TIMI2/3#flow#before#PTCA# #####7#inappropriate#loca.on#of# ########coronary#artery#occlusion# #####2#CKMB#missing#points#(death)# #####1#external#electric#shock# ########within#first#3#days# #####1#TIMI#0/1#aRer#PTCA# #####1#urgent#cardiac#surgery## (septal#defect)#
36#assigned#to#RIper#group#
16#excluded#because#did#not# meet#study#criteria# ####10#TIMI2/3#flow#before#PTCA# #####6#inappropriate#loca.on#of# ########coronary#artery#occlusion# ###### # # # # # 51#excluded#because#did#not# meet#study#criteria# ####22#TIMI2/3#flow#before#PTCA# ####12#inappropriate#loca.on#of# ########coronary#artery#occlusion# #####1#CKMB#missing#points#(death)# #####3#external#electric#shock# ########within#first#3#days# ####13#inappropriate#case#for# #########direct#sten.ng#procedure# # 3#excluded#at#the#.me#of#blinded# analysis# ####1#significant#collateral# ########circula.on#(Rentrop#2)# #####1#uninterruptable#AUC#CKMB# #######because#of#missing#points# ####1#previous#MI#in#the#same# ########coronary#territory#
17#eligible#for#CKMB#analysis# 18#eligible#for#CKMB#analysis#
2#excluded#excluded#at#the#.me#
- f#blinded#analysis#
#####1#significant#collateral# ########circula.on#(Rentrop#2)# #####1#TIMI#1#aRer#PTCA# # # #
20#eligible#for#CKMB#analysis#
0#excluded#at#the#.me#of#blinded# analysis# # # # # # #
Unpublished data