Blood Pressure Cuff Could Save Heart Attack Patients

Intermittent inflation of a blood pressure cuff reduces subsequent cardiac symptoms and mortality after acute myocardial infarction (MI), according to a new study.

Researchers at Aarhus University (Denmark), John Radcliffe Hospital (Oxford, United Kingdom), and other institution investigated the effect of remote ischemic conditioning—the alternating inflation of a blood pressure cuff to cut off blood flow to the arm during transportation to hospital—on long-term clinical outcome. To do so, 333 patients with a suspected first acute ST-elevation myocardial infarction (STEMI) were randomized to receive primary percutaneous coronary intervention (PCI) with or without prior remote ischemic conditioning.

The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause mortality, MI, readmission for heart failure, and ischemic stroke/transient ischemic attack. The results showed that in the per-protocol analysis of the 251 patient fulfilling trial criteria after a median follow-up of 3.8 years, MACCE occurred for 17 (13.5%) patients in the intervention group, compared with 32 (25.6%) patients in the control group, yielding a hazard ratio (HR) of 0.49, with the HR for all-cause mortality at 0.32. The study was published online on September 12, 2013, in the European Heart Journal.

“In patients treated with conditioning, a blood pressure cuff was placed around the upper arm and inflated to 200 mmHg for 5 minutes to cut off blood flow, and then released,” said senior author Prof. Hans Erik Botker, MD, PhD, and colleagues of the department of cardiology. “The arm then rested for 5 minutes, and then the blood pressure cuff was reapplied. This procedure was repeated four times.”

The underlying mechanisms involved in remote ischemic conditioning are thought to involve activation of endogenous protective systems that induce resistance towards tissue damage in the heart during a heart attack, and in particular when reopening the occluded heart vessel by balloon dilatation.

Related Links:
Aarhus University
John Radcliffe Hospital