Babu, GG; (2012) Remote ischaemic preconditioning in the settings of cardiac bypass surgery and coronary angioplasty. Doctoral thesis , UCL (University College London).

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Abstract

Myocardial revascularisation in the form of coronary artery bypass surgery (CABG) and percutaneous coronary interventions (PCI) are the two important treatment strategies in combating ischaemic heart disease. There have been tremendous improvements in many aspects of these revascularisation methods over the years. However both these forms of revascularisation can have a deleterious effect on the myocardium while its vascularity is re-established. This revascularisation induced myocardial injury is one of the prognostically important deleterious effects. Consequently, many therapeutic strategies are being studied which can cardioprotect and reduce peri-operative myocardial injury during CABG and peri-procedural myocardial injury during PCI. We evaluate Remote ischaemic preconditioning, a cardioprotective strategy, for its effect on myocardial revascularisation methods of PCI and CABG. In the PCI settings, the beneficial effect of remote ischaemic preconditioning in patients undergoing elective PCI has now been established. However its role in patients admitted with Non ST elevation acute coronary syndrome (NSEACS) and undergoing urgent PCI is still unknown. This group of patients particularly has increased peri-procedural myocardial injury due to their soft coronary plaque and thrombi. In the CABG settings, remote preconditioning has been shown reduce perioperative myocardial injury in non diabetic patients. There are no clinical studies looking at the beneficial effect of remote preconditioning in diabetic cohort of patients undergoing CABG. In animal models, diabetic myocardium is known to possess higher threshold for preconditioning, albeit still possible to precondition. As diabetic patients, are more vulnerable for myocardial injury during CABG and also tolerate the injury relatively poorly compared to their non diabetic counterparts, it is important to explore for cardioprotective strategies to be applied to this high risk diabetic population. The two clinical studies in this thesis evaluate the effect of remote ischemic preconditioning in a) reducing peri-procedural myocardial injury in patients with NSTEACS undergoing urgent percutaneous intervention and b) reducing peri-operative myocardial injury in type 2 diabetic patients undergoing coronary artery bypass surgery.

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