Impact of remote ischemic preconditioning on the T-lymphocyte mitochondrial damage index: a randomized clinical trial

Background: The role of remote ischemic preconditioning (RIPC) in coronary heart disease patients remains uncertain. This study was aimed to assess the RIPC influence on T-lymphocyte mitochondrial damage index (MDI), high-sensitivity troponin-T (hs-TnT) concentration, and the perioperative incidence of adverse events in ST-segment elevation myocardial infarction (STEMI) patients having exceeded the window for emergency reperfusion therapy. Furthermore, the goal was to determine myocardial protective effects of RIPC and investigate its underlying mechanisms. Methods: STEMI patients having surpassed the reperfusion therapy time window were randomly assigned to RIPC (n = 32) and control (n = 32) groups. RIPC group underwent upper limb RIPC (four cycles of 5-min cuff inflation to 200 mmHg followed by 5-min of deflation). T-lymphocyte MDI and hs-TnT concentrations were determined once on admission, and then 2 hours before the percutaneous coronary intervention (PCI), conducted after 10 days. Perioperative incidence for no-reflow, cardiac rupture and malignant arrhythmias were recorded. Results: T-lymphocyte MDI and hs-TnT concentrations upon admission did not differ much in both groups, however, there was a decrease after 10 days, and of greater magnitude in RIPC group. Conclusions: RIPC group exhibited lower incidence of no-reflow during PCI compared to that of control (p = 0.03). RIPC has the potential to mitigate perioperative myocardial injuries in STEMI patients by reducing T-lymphocyte MDI, inhibiting myocardial cell death, and lowering no-reflow risk during PCI. Clinical Trial Registration: Registered website: https://clinicaltrials.gov/search?cond=NCT04766749. Registered number: NCT04766749. Registered date: 10/02/2021.