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

• Type: Article in International Scientific Journal
• Date: 2018

Authors

Gaspar, A (Author) Other; Andre P Lourenco (Author) FMUP; Pereira, MA (Author) Other; Azevedo, P (Author) Other; Roncon-Albuquerque R Jr (Author) FMUP; Paulo Farinha Marques (Author) FCUP; Leite-Moreira AF (Author) FMUP

Journal

Title: Basic Research in Cardiology

Vol. 113

ISSN: 0300-8428

Publisher: Springer Nature

Indexing

ISI Web of Knowledge - 131 Citations

Scopus - 137 Citations

Other information

Authenticus ID: P-00N-QA8

DOI: 10.1007/s00395-018-0672-3

Abstract (EN): To test whether remote ischaemic conditioning (RIC) as adjuvant to standard of care (SOC) would prevent progression towards heart failure (HF) after ST-elevation myocardial infarction (STEMI). Single-centre parallel 1: 1 randomized trial (computerized block-randomization, concealed allocation) to assess superiority of RIC (3 cycles of intermittent 5 min lower limb ischaemia) over SOC in consecutive STEMI patients (NCT02313961, clinical trials. gov). From 258 patients randomized to RIC or SOC, 9 and 4% were excluded because of unconfirmed diagnosis and previously unrecognized exclusion criteria, respectively. Combined primary outcome of cardiac mortality and hospitalization for HF was reduced in RIC compared with SOC (n = 231 and 217, respectively; HR = 0.35, 95% CI 0.15-0.78) as well as each outcome in isolation. No difference was found in serum troponin I levels between groups. Median and maximum follow-up time were 2.1 and 3.7 years, respectively. In-hospital HF (RR = 0.68, 95% CI 0.47-0.98), need for diuretics (RR = 0.68, 95% CI 0.48-0.97) and inotropes and/or intra-aortic balloon pump (RR = 0.17, 95% CI 0.04-0.76) were decreased in RIC. On planned 12 months follow-up echocardiography (n = 193 and 173 in RIC and SOC, respectively) ejection fraction (EF) recovery was enhanced in patients presenting with impaired left ventricular (LV) function (10% absolute difference in median EF compared with SOC; P < 0.001). In addition to previously reported improved myocardial salvage index and reduced infarct size RIC was shown beneficial in a combined hard clinical endpoint of cardiac mortality and hospitalization for HF. Improved EF recovery was also documented in patients with impaired LV function.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 10