Remote Ischemic Conditioning Did Not Improve 12 Month Clinical Outcomes After STEMI

Adjunctive remote ischemic conditioning in patients undergoing treatment for ST-elevation myocardial infarction (STEMI) does not improve clinical outcomes at 12 months, according to study findings published in The Lancet.

The investigators of the prospective, single-blind, randomized controlled trial examined whether cardioprotective remote ischemic conditioning could reduce the frequency of cardiac death and hospitalization for heart failure at 12 months postintervention in patients with myocardial infarction.

The study included 5115 adults with suspected STEMI from 33 centers across the United Kingdom, Denmark, Spain, and Serbia. All participants were eligible to undergo primary percutaneous coronary intervention (PPCI) and were randomly assigned to receive standard treatment (n=2569), sometimes with sham conditioning, or adjunctive remote ischemic conditioning (n=2546) prior to PPCI.

Remote ischemic conditioning treatment involved alternating ischemia and reperfusion applied to the arm through 4 cycles of inflation (5 minutes) and deflation (5 minutes) using an automated cuff device. The primary end point was the combined frequency of cardiac death or hospitalization for heart failure at 12 months postrandomization in the intention-to-treat population.

At 12 months post-PPCI, cardiac death or hospitalization for heart failure was observed in 239 participants (9.4%) from the remote ischemic conditioning group and 220 participants (8.6%) from the control group (hazard ratio, 1.10; 95% CI, 0.91-1.32; P =.32).

Analyzing individual outcomes, the investigators suggested that there was also no difference between control and remote ischemic conditioning groups. No major unexpected adverse events or treatment-related side effects were reported in either group.

A limitation of the study was the short follow-up time of 12 months, which was potentially too short to observe the effects of remote ischemic conditioning on clinical outcomes.

Based on their findings, the investigators suggest that in patients with STEMI undergoing PPCI, adjunctive remote ischemic conditioning has no clinically meaningful beneficial effects on outcomes of cardiac death or hospitalization for heart failure at 12 months.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference          

Hausenloy DJ, Kharbanda RK, Møller UK, et al. Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial [published online September 6, 2019]. Lancet. doi:10.1016/S0140-6736(19)32039-2