PMID- 34417205
OWN - NLM
STAT- MEDLINE
DCOM- 20220412
LR  - 20220517
IS  - 1468-201X (Electronic)
IS  - 1355-6037 (Linking)
VI  - 108
IP  - 9
DP  - 2022 May
TI  - Remote ischaemic conditioning in ST elevation myocardial infarction: a 
      registry-based randomised trial.
PG  - 703-709
LID - 10.1136/heartjnl-2021-319455 [doi]
AB  - OBJECTIVES: Remote ischaemic conditioning (RIC) has been tested as a possible 
      strategy for mitigating reperfusion injury in ST elevation myocardial infarction 
      (STEMI) with primary percutaneous coronary intervention (PPCI). However, 
      surrogate outcomes have shown inconsistent effects with lack of clinical 
      correlation. METHODS: We performed a registry-based randomised study of patients 
      with STEMI allocated to RIC (4 cycles of blood pressure cuff inflation to 200 mm 
      Hg for 5 min of ischaemia followed by 5 min of reperfusion) or standard of care 
      (SOC) during PPCI. We examined the associations of RIC on core laboratory 
      measurements of myocardial perfusion, infarct size (IS), left ventricular (LV) 
      performance and clinical outcomes. RESULTS: A total of 252 patients were 
      enrolled. The median age was 61 (IQR: 55-70) years and 72.8% were male. Sum ST 
      segment deviation resolution >/=50% was similar between RIC and SOC (65.2% vs 
      55.7%, p=0.269). In those with 3-day cardiovascular MRI (n=88), no difference in 
      median (25th, 75th percentiles) IS (14.9% (4.5%, 23.1%) vs 16.1% (3.3%, 22.0%), 
      p=0.980), LV dimensions (LV end-diastolic volume index: 78.7 (71.1, 91.2) mL/m(2) 
      vs 79.9 (71.2, 88.8) mL/m(2), p=0.630; LV end-systolic volume index: 48.8 (35.7, 
      51.4) mL/m(2) vs 37.9 (31.8, 47.5) mL/m(2), p=0.551) or ejection fraction (50.0% 
      (41.0%-55.0%) vs 50.0% (43.0%-56.0%), p=0.554) was demonstrated. Similar results 
      were observed with 90-day cardiovascular MRI. At 1 year, the clinical composite 
      of death, congestive heart failure, cardiogenic shock and recurrent myocardial 
      infarction was similar in RIC and SOC (21.7% vs 13.3%, p=0.110). CONCLUSIONS: In 
      a contemporary registry-based randomised study of patients with STEMI undergoing 
      PPCI, adjunctive therapy with RIC did not improve myocardial perfusion, reduce IS 
      or alter LV performance. Consequently, there was no difference in clinical 
      outcomes within 1 year. TRIAL REGISTRATION NUMBER: NCT03930589.
CI  - (c) Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and 
      permissions. Published by BMJ.
FAU - Bainey, Kevin R
AU  - Bainey KR
AUID- ORCID: 0000-0002-5458-4617
AD  - Divison of Cardiology, Department of Medicine, University of Alberta, Edmonton, 
      Alberta, Canada kevin.bainey@albertahealthservices.ca.
AD  - Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
AD  - Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada.
FAU - Zheng, Yinggan
AU  - Zheng Y
AD  - Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
FAU - Coulden, Richard
AU  - Coulden R
AD  - Divison of Cardiology, Department of Medicine, University of Alberta, Edmonton, 
      Alberta, Canada.
AD  - Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton, 
      Alberta, Canada.
FAU - Sonnex, Emer
AU  - Sonnex E
AD  - Divison of Cardiology, Department of Medicine, University of Alberta, Edmonton, 
      Alberta, Canada.
AD  - Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton, 
      Alberta, Canada.
FAU - Thompson, Richard
AU  - Thompson R
AD  - Divison of Cardiology, Department of Medicine, University of Alberta, Edmonton, 
      Alberta, Canada.
FAU - Mei, Junyi
AU  - Mei J
AD  - Divison of Cardiology, Department of Medicine, University of Alberta, Edmonton, 
      Alberta, Canada.
FAU - Bastiany, Alexandra
AU  - Bastiany A
AD  - Divison of Cardiology, Department of Medicine, University of Alberta, Edmonton, 
      Alberta, Canada.
FAU - Welsh, Robert
AU  - Welsh R
AD  - Divison of Cardiology, Department of Medicine, University of Alberta, Edmonton, 
      Alberta, Canada.
AD  - Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
AD  - Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada.
LA  - eng
SI  - ClinicalTrials.gov/NCT03930589
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20210820
PL  - England
TA  - Heart
JT  - Heart (British Cardiac Society)
JID - 9602087
SB  - IM
MH  - Humans
MH  - Ischemia/etiology
MH  - Male
MH  - Middle Aged
MH  - *Percutaneous Coronary Intervention/adverse effects
MH  - Registries
MH  - *ST Elevation Myocardial Infarction/diagnostic imaging/therapy
MH  - Treatment Outcome
OTO - NOTNLM
OT  - acute coronary syndrome
COIS- Competing interests: None declared.
EDAT- 2021/08/22 06:00
MHDA- 2022/04/13 06:00
CRDT- 2021/08/21 05:34
PHST- 2021/03/30 00:00 [received]
PHST- 2021/07/29 00:00 [accepted]
PHST- 2021/08/22 06:00 [pubmed]
PHST- 2022/04/13 06:00 [medline]
PHST- 2021/08/21 05:34 [entrez]
AID - heartjnl-2021-319455 [pii]
AID - 10.1136/heartjnl-2021-319455 [doi]
PST - ppublish
SO  - Heart. 2022 May;108(9):703-709. doi: 10.1136/heartjnl-2021-319455. Epub 2021 Aug 
      20.