Article Text

Download PDFPDF
Original research
Remote ischaemic conditioning in ST elevation myocardial infarction: a registry-based randomised trial
  1. Kevin R Bainey1,2,3,
  2. Yinggan Zheng2,
  3. Richard Coulden1,4,
  4. Emer Sonnex1,4,
  5. Richard Thompson1,
  6. Junyi Mei1,
  7. Alexandra Bastiany1,
  8. Robert Welsh1,2,3
  1. 1Divison of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
  2. 2Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
  3. 3Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
  4. 4Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton, Alberta, Canada
  1. Correspondence to Dr Kevin R Bainey, University of Alberta, Edmonton, AB T6G 2R3, Canada; kevin.bainey{at}albertahealthservices.ca

Abstract

Objectives Remote ischaemic conditioning (RIC) has been tested as a possible strategy for mitigating reperfusion injury in ST elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PPCI). However, surrogate outcomes have shown inconsistent effects with lack of clinical correlation.

Methods We performed a registry-based randomised study of patients with STEMI allocated to RIC (4 cycles of blood pressure cuff inflation to 200 mm Hg for 5 min of ischaemia followed by 5 min of reperfusion) or standard of care (SOC) during PPCI. We examined the associations of RIC on core laboratory measurements of myocardial perfusion, infarct size (IS), left ventricular (LV) performance and clinical outcomes.

Results A total of 252 patients were enrolled. The median age was 61 (IQR: 55–70) years and 72.8% were male. Sum ST segment deviation resolution ≥50% was similar between RIC and SOC (65.2% vs 55.7%, p=0.269). In those with 3-day cardiovascular MRI (n=88), no difference in median (25th, 75th percentiles) IS (14.9% (4.5%, 23.1%) vs 16.1% (3.3%, 22.0%), p=0.980), LV dimensions (LV end-diastolic volume index: 78.7 (71.1, 91.2) mL/m2 vs 79.9 (71.2, 88.8) mL/m2, p=0.630; LV end-systolic volume index: 48.8 (35.7, 51.4) mL/m2 vs 37.9 (31.8, 47.5) mL/m2, p=0.551) or ejection fraction (50.0% (41.0%–55.0%) vs 50.0% (43.0%–56.0%), p=0.554) was demonstrated. Similar results were observed with 90-day cardiovascular MRI. At 1 year, the clinical composite of death, congestive heart failure, cardiogenic shock and recurrent myocardial infarction was similar in RIC and SOC (21.7% vs 13.3%, p=0.110).

Conclusions In a contemporary registry-based randomised study of patients with STEMI undergoing PPCI, adjunctive therapy with RIC did not improve myocardial perfusion, reduce IS or alter LV performance. Consequently, there was no difference in clinical outcomes within 1 year.

Trial registration number NCT03930589.

  • acute coronary syndrome

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

Statistics from Altmetric.com

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

View Full Text

Footnotes

  • Contributors KB, YZ, RC, ES, RT, and RW were involved with the planning, conducting and reporting of work. JM and AB were involved in the reporting of work.

  • Funding We would like to acknowledge the University Hospital Foundation at the University of Alberta for funding provided for this study.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.