Randomized controlled trial of remote ischaemic conditioning in ST‑elevation myocardial infarction as adjuvant to primary angioplasty (RIC‑STEMI)

Ischaemic heart disease (IHD) and myocardial infarction (MI) remain the leading cause of mortality in Europe [22]. ST-elevation myocardial infarction (STEMI) incidence declined due to aggressive control of risk factors while mortality was reduced by combined effects of timely primary percutaneous coronary intervention (PCI) and optimized medical therapy [4, 10]. An increasing number of survivors, however, are at risk of left ventricular (LV) dysfunction [17]. PCI worsens ischaemia–reperfusion injury (IRI), which later accounts for larger infarct size and ensuing heart failure (HF) [7]. Indeed, 6-month mortality figures after STEMI remain high, warranting a shift in focus towards HF prevention [6]. The rationale underlying protection by ischaemic conditioning has been extensively reviewed [11, 14], but translation to the clinics has been unwieldy [10, 12]. From various alternatives remote ischaemic conditioning (RIC) seems the most promising [10]. Myocardial salvage index was improved 30 days after PCI in STEMI patients assigned to concomitant RIC [2] as was long-term prognosis in post hoc analysis [21]. A recent meta-analysis concluded that RIC is a promising adjunctive treatment to PCI for prevention of IRI in STEMI [18]. Most importantly, larger studies addressing hard clinical endpoints as primary outcome measures are warranted [10].

Our aim was to test the hypothesis that RIC as adjuvant therapy to standard of care PCI (SOC) could reduce a combined primary outcome measure of cardiac mortality and hospitalization for HF on follow-up after STEMI.