Potential mechanical strategies for reducing MI size and improving clinical outcomes in patients presenting with reperfused STEMI
| Clinical study | Therapeutic intervention/patient characteristics | N | Main outcomes | Comments |
|---|---|---|---|---|
| Ischaemic postconditioning (major studies only) | ||||
| Staat et al27 | 4×1 min angioplasty balloon inflations/deflations (All comer STEMI, TIMI 0) | 30 | 36% reduction in MI size (72 h AUC Total CK) | First study to demonstrate reduction in MI size with IPost |
| Thibault et al28 | 4×1 min angioplasty balloon inflations/deflations (All comer STEMI, TIMI 0) | 38 | 39% reduction in MI size (6 months SPECT) 7% absolute increase in LVEF at 12 months | First study to demonstrate long-term cardioprotection with IPost |
| Sorensson et al29 | 4×1-min angioplasty balloon inflations/deflations (All comer STEMI, TIMI 0) | 76 | No difference in MI size overall However, reduction in MI size in patients with large AAR | |
| Hahn et al30 | 4×1 min angioplasty balloon inflations/deflations (All comer STEMI, TIMI 0) | 700 | No difference in the primary end point of complete ST-segment resolution at 30 min post-PPCI | Largest neutral study with IPost. IPost performed at site of culprit lesion and MI size not measured. |
| Hofsten et al DANAMI-331 | 4×0.5 min angioplasty balloon inflations/deflations (All comer STEMI, TIMI 0/1) | 2000 | Ongoing study Primary end point of all-cause mortality and heart failure at 2 years | Recruitment complete and follow-up in process Results due First study to investigate the effect of IPost on long-term clinical outcomes |
| Remote ischaemic conditioning | ||||
| Botker et al32 | 4×5 min arm cuff inflations/deflations in the ambulance prior to PPCI (All comer STEMI) | 142 | Increase in myocardial salvage index at 30 days No difference in MI size (SPECT or peak Trop-I) | First study to test effect of RIC in PPCI-treated patients presenting with STEMI. Reduced MI size in LAD STEMI. |
| Rentoukas et al33 | 4×4 min arm cuff inflations/deflations at the hospital prior to PPCI (All comer STEMI) | 93 | Better ST segment resolution and lower peak Trop-I. Synergistic effects with morphine | |
| Crimi et al34 | 3×5-min thigh cuff inflations/ deflations at onset of reperfusion by PPCI (LAD STEMI) | 100 | 20% reduction in MI size (72 h AUC CK-MB) | First study to show benefit with RIC started at onset of reperfusion |
| White et al35 ERIC-STEMI | 4×5 min arm cuff inflations/deflations at the hospital prior to PPCI (All comer STEMI) | 197 | 27% reduction in MI size (acute CMR) | |
| Sloth et al36 | 4×5 min upper arm cuff inflations/deflations in the ambulance prior to PPCI (All comer STEMI) | 251 | 51% reduction in composite end point of all-cause mortality, non-fatal MI, TIA or stroke, HHF at 3.8 years | First study to show an effect of RIC on long-term outcomes following PPCI (secondary end point) |
| Prunier et al37 RIPOST-MI | 4×5 min arm cuff inflations/deflations at hospital prior to PPCI with or without IPost (All comer STEMI) | 151 | No difference in reduction in enzymatic MI size (CK-MB) with RIC vs RIC+IPost (31% vs 19%) | First study to test the effect of a combined therapeutic approach with RIC and IPost |
| Yellon et al38 ERIC-LYSIS | 4×5 min arm cuff inflations/deflations at hospital prior to thrombolysis (All comer STEMI) | 519 | 19% reduction in enzymatic MI size (CK-MB) 32% reduction in enzymatic MI size (Trop-T) | First study to test the effect of RIC in patients presenting with thrombolysed STEMI |
| Eitel et al39 5 LIPSIA | 3×5 min arm cuff inflations/deflations at hospital prior to PPCI with IPost (All comer STEMI) | 696 | Increased myocardial salvage index (CMR at 3 days) with RIC+IPost when compared with control (49 (IQR 30–72) vs 40 (IQR 16–68), p=0.02) | Largest study to test the effect of a combined therapeutic approach with RIC and IPost No beneficial effect with IPost alone |
| RIC-STEMI NCT02313961 | 3×5 min thigh cuff inflations/deflations prior to PPCI (All comer STEMI) | 492 | Ongoing study Primary end point of cardiac death and HHF at 12 months | |
| CONDI-2/ERIC-PPCI (NCT02342522) (NCT01857414) | 4×5 min arm cuff inflations/deflations prior to PPCI (All comer STEMI) | 4300 | Ongoing study Primary end point of cardiac death and HHF at 12 months | Collaboration between UK, Denmark and Spain First study to investigate effect of RIC on long-term outcomes following PPCI |
AAR, area-at-risk; AUC, area under curve; CK, creatine kinase; CK-MB, creatine kinase MB isoenzyme; CMR, cardiovascular magnetic resonance; HHF, hospitalisation for heart failure; IPost, Ischaemic postconditioning; LAD, left anterior descending artery; LVEF, left ventricular ejection fraction; MI, myocardial infarct; PPCI, primary percutaneous coronary intervention; RIC, remote ischaemic conditioning; SPECT, single-photon emission CT; STEMI, ST-segment elevation myocardial infarction; TIA, transient ischaemic attack; TIMI, Thrombolysis in Myocardial infarction; Trop, Troponin.