Key result
Combined RIC and postconditioning increases myocardial salvage index ~23% over conventional PCI.
Why the study?
Does combined intrahospital remote ischaemic perconditioning and postconditioning improve myocardial salvage in STEMI patients undergoing primary PCI?
RCT (n=696)
randomized
No
Does combined intrahospital remote ischaemic perconditioning and postconditioning improve myocardial salvage in STEMI patients undergoing primary PCI?
Absolute Event Rate: 49% vs 40%
p-value: p=0.02
Combined intrahospital remote ischaemic perconditioning and postconditioning during primary PCI for STEMI improves myocardial salvage compared to conventional PCI, though it did not translate to improved clinical outcomes at 6 months.
AIMS: Remote ischaemic conditioning (RIC) and postconditioning (PostC) are both potent activators of innate protection against ischaemia-reperfusion injury and have demonstrated cardioprotection in experimental and clinical ST-elevation myocardial infarction (STEMI) trials. However, their combined effects have not been studied in detail. The aim of this study was to evaluate if the co-application of intrahospital RIC and PostC has a more powerful effect on myocardial salvage compared with either PostC alone or control. METHODS AND RESULTS: This prospective, controlled, single-centre study randomized 696 STEMI patients to one of the following three groups: (i) combined intrahospital RIC + PostC in addition to primary percutaneous coronary intervention (PCI); (ii) PostC in addition to PCI; and (iii) conventional PCI (control). The primary endpoint myocardial salvage index was assessed by cardiac magnetic resonance (CMR) imaging within 3 days after infarction. Secondary endpoints included infarct size and microvascular obstruction (MVO) assessed by CMR. The combined clinical endpoint consisted of death, reinfarction, and new congestive heart failure within 6 months. The primary endpoint myocardial salvage index was significantly greater in the combined RIC + PostC group when compared with the control group (49 [interquartile range 30-72] vs. 40 [interquartile range 16-68], P = 0.02). Postconditioning alone failed to improve myocardial salvage when compared with conventional PCI (P = 0.39). The secondary endpoints, including infarct size and MVO, showed no significant differences between groups. Clinical follow-up at 6 months revealed no differences in the combined clinical endpoint between groups (P = 0.44). CONCLUSION: Combined intrahospital RIC + PostC in conjunction with PCI in STEMI significantly improves myocardial salvage in comparison with control and PostC. CLINICALTRIALSGOV: NCT02158468.
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Eitel et al. (2015) conducted an RCT in ST-elevation myocardial infarction (STEMI) (n=696). Combined intrahospital remote ischaemic conditioning (RIC) and postconditioning (PostC) vs. Conventional PCI (control) or PostC alone was evaluated on Myocardial salvage index assessed by cardiac magnetic resonance (CMR) imaging within 3 days after infarction (p=0.02). Combined intrahospital remote ischaemic conditioning and postconditioning significantly improved myocardial salvage index compared with conventional PCI (49 vs 40; P=0.02).
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