Remote ischemic conditioning does not offer any clinical benefit to patients with ST-segment elevation acute myocardial infarction undergoing primary angioplasty, according to this study presented on Sunday at the European Society of Cardiology Congress 2019.
Prior studies were limited and small, but this analysis seems to provide definitive evidence with regard to ischemic pre-conditioning. The way to improve must be found somewhere else.
The study randomized 5401 patients with ST-segment elevation acute myocardial infarction undergoing primary angioplasty to remote ischemic pre-conditioning (either in the ambulance or on hospital admission) or not. The pre-conditioning procedure was performed intermittently through four cycles of 5-minute inflation of a blood-pressure cuff.
After 1 year of follow-up, there were no differences between the control and active groups regarding the primary endpoint of cardiac death or heart failure readmission. There were also no differences in the secondary endpoints (a composite of cardiac death and heart failure readmission at 30 days, and major adverse cardiac or cerebrovascular events [MACCE] at 30 days and 1 year).
Results were consistent across subgroups (by age, diabetes status, infarct location, final TIMI flow, and time elapsed from first medical contact to balloon inflation).
Other forms of ischemic pre-conditioning, such as pharmacologic compounds (exenatide and cyclosporin) or mechanical postconditioning and balloon reinflation in the coronary artery, have also failed.
Original Title: Effect of remote ischaemic conditioning on clinical outcomes in patients with STEMI undergoing primary PCI: the CONDI-2/ERIC-PPCI trial.
Reference: Botker HE. Presentado el 1 de septiembre en el ESC 2019. Paris, Francia.
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