Abstract
The effect of limb remote ischaemic conditioning (RIC) on myocardial infarct (MI) size and left ventricular ejection fraction (LVEF) was investigated in a pre-planned cardiovascular magnetic resonance (CMR) substudy of the CONDI-2/ERIC-PPCI trial. This single-blind multi-centre trial (7 sites in UK and Denmark) included 169 ST-segment elevation myocardial infarction (STEMI) patients who were already randomised to either control (n = 89) or limb RIC (n = 80) (4 × 5 min cycles of arm cuff inflations/deflations) prior to primary percutaneous coronary intervention. CMR was performed acutely and at 6 months. The primary endpoint was MI size on the 6 month CMR scan, expressed as median and interquartile range. In 110 patients with 6-month CMR data, limb RIC did not reduce MI size [RIC: 13.0 (5.1–17.1)% of LV mass; control: 11.1 (7.0–17.8)% of LV mass, P = 0.39], or LVEF, when compared to control. In 162 patients with acute CMR data, limb RIC had no effect on acute MI size, microvascular obstruction and LVEF when compared to control. In a subgroup of anterior STEMI patients, RIC was associated with lower incidence of microvascular obstruction and higher LVEF on the acute scan when compared with control, but this was not associated with an improvement in LVEF at 6 months. In summary, in this pre-planned CMR substudy of the CONDI-2/ERIC-PPCI trial, there was no evidence that limb RIC reduced MI size or improved LVEF at 6 months by CMR, findings which are consistent with the neutral effects of limb RIC on clinical outcomes reported in the main CONDI-2/ERIC-PPCI trial.
Highlights
Mortality and heart failure in ST-segment elevation myocardial infarction (STEMI) patients reperfused by primary percutaneous coronary intervention (PPCI) remain significantRohin Francis and Jun Chong are joint first authors.Derek J
1264 patients were recruited at the 7 cardiovascular magnetic resonance (CMR) sites, and of these 169 patients were recruited into the CMR substudy between 7 January 2016 and 26 March 2018, with 162 having analysable acute CMR scans performed at a median of 2 days post-PPCI
In this pre-planned CMR substudy of the CONDI-2/ERICPPCI trial, limb remote ischaemic conditioning (RIC) applied as an adjunct to PPCI had no observed beneficial effects on the primary endpoint of chronic MI size at 6 months post-PPCI, or the secondary endpoints of acute MI size, myocardial salvage index or left ventricular (LV) ejection fraction when compared to control
Summary
Mortality and heart failure in ST-segment elevation myocardial infarction (STEMI) patients reperfused by primary percutaneous coronary intervention (PPCI) remain significantRohin Francis and Jun Chong are joint first authors.Derek J. New treatments that can be administered as adjuncts to PPCI, are needed to reduce myocardial infarct (MI) size, prevent adverse post-infarct left ventricular (LV) remodelling, and reduce the risk of developing heart failure (HF) [13, 21, 27, 29] In this regard, remote ischaemic conditioning (RIC), in which brief cycles of non-lethal ischaemia and reperfusion are applied to an organ or tissue (including the arm or leg) away from the heart, has been shown to reduce MI size in small and large animal models of acute myocardial ischaemia/reperfusion injury (IRI) [11, 25, 28, 37]. The RIC stimulus can be non-invasively applied to the arm or leg using serial inflations and deflations (3–4 × 5 min cycles) of a pneumatic cuff placed on the upper arm or thigh, to induce brief
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