Remote ischaemic conditioning before hospital admission, as a complement to angioplasty, and effect on myocardial salvage in patients with acute myocardial infarction: a randomised trial.

Remote ischaemic conditioning before hospital admission, as a complement to angioplasty, and effect on myocardial salvage in patients with acute myocardial infarction: a randomised trial.

MedLine Citation:	PMID: 20189026 Owner: NLM Status: MEDLINE
Abstract/OtherAbstract:	BACKGROUND: Remote ischaemic preconditioning attenuates cardiac injury at elective surgery and angioplasty. We tested the hypothesis that remote ischaemic conditioning during evolving ST-elevation myocardial infarction, and done before primary percutaneous coronary intervention, increases myocardial salvage. METHODS: 333 consecutive adult patients with a suspected first acute myocardial infarction were randomly assigned in a 1:1 ratio by computerised block randomisation to receive primary percutaneous coronary intervention with (n=166 patients) versus without (n=167) remote conditioning (intermittent arm ischaemia through four cycles of 5-min inflation and 5-min deflation of a blood-pressure cuff). Allocation was concealed with opaque sealed envelopes. Patients received remote conditioning during transport to hospital, and primary percutaneous coronary intervention in hospital. The primary endpoint was myocardial salvage index at 30 days after primary percutaneous coronary intervention, measured by myocardial perfusion imaging as the proportion of the area at risk salvaged by treatment; analysis was per protocol. This study is registered with ClinicalTrials.gov, number NCT00435266. FINDINGS: 82 patients were excluded on arrival at hospital because they did not meet inclusion criteria, 32 were lost to follow-up, and 77 did not complete the follow-up with data for salvage index. Median salvage index was 0.75 (IQR 0.50-0.93, n=73) in the remote conditioning group versus 0.55 (0.35-0.88, n=69) in the control group, with median difference of 0.10 (95% CI 0.01-0.22; p=0.0333); mean salvage index was 0.69 (SD 0.27) versus 0.57 (0.26), with mean difference of 0.12 (95% CI 0.01-0.21; p=0.0333). Major adverse coronary events were death (n=3 per group), reinfarction (n=1 per group), and heart failure (n=3 per group). INTERPRETATION: Remote ischaemic conditioning before hospital admission increases myocardial salvage, and has a favourable safety profile. Our findings merit a larger trial to establish the effect of remote conditioning on clinical outcomes. FUNDING: Fondation Leducq.

Authors:	Hans Erik B?tker; Rajesh Kharbanda; Michael R Schmidt; Morten B?ttcher; Anne K Kaltoft; Christian J Terkelsen; Kim Munk; Niels H Andersen; Troels M Hansen; Sven Trautner; Jens Flensted Lassen; Evald H?j Christiansen; Lars R Krusell; Steen D Kristensen; Leif Thuesen; S?ren S Nielsen; Michael Rehling; Henrik Toft S?rensen; Andrew N Redington; Torsten T Nielsen
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Publication Detail:	Type: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
Journal Detail:	Title: Lancet Volume: 375 ISSN: 1474-547X ISO Abbreviation: Lancet Publication Date: 2010 Feb
Date Detail:	Created Date: 2010-03-01 Completed Date: 2010-03-15 Revised Date: 2010-05-17
Medline Journal Info:	Nlm Unique ID: 2985213R Medline TA: Lancet Country: England
Other Details:	Languages: eng Pagination: 727-34 Citation Subset: AIM; IM
Copyright Information:	Copyright 2010 Elsevier Ltd. All rights reserved.
Affiliation:	Department of Cardiology, Aarhus University Hospital Skejby, Aarhus N, Denmark. heb@dadlnet.dk
Data Bank Information
Bank Name/Acc. No.:	ClinicalTrials.gov/NCT00435266
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MeSH Terms
Descriptor/Qualifier:	Angioplasty, Balloon, Laser-Assisted Angioplasty, Transluminal, Percutaneous Coronary* Antibodies, Monoclonal / administration & dosage Arm / blood supply Aspirin / administration & dosage Drug Therapy, Combination Echocardiography Electrocardiography Female Hospitalization Humans Immunoglobulin Fab Fragments / administration & dosage Ischemic Preconditioning, Myocardial / methods* Male Middle Aged Myocardial Infarction / therapy* Myocardial Reperfusion Injury / prevention & control* Myocardium / pathology Platelet Aggregation Inhibitors / administration & dosage Prospective Studies Radiopharmaceuticals / diagnostic use Technetium Tc 99m Sestamibi / diagnostic use Ticlopidine / administration & dosage, analogs & derivatives Time Factors Tomography, Emission-Computed, Single-Photon Treatment Outcome Troponin T / blood
Chemical
Reg. No./Substance:	0/Antibodies, Monoclonal; 0/Immunoglobulin Fab Fragments; 0/Platelet Aggregation Inhibitors; 0/Radiopharmaceuticals; 0/Troponin T; 109581-73-9/Technetium Tc 99m Sestamibi; 143653-53-6/abciximab; 50-78-2/Aspirin; 55142-85-3/Ticlopidine; 90055-48-4/clopidogrel
Comments/Corrections
Comment In:	Lancet. 2010 Feb 27;375(9716):699-700 [PMID: 20189010 ] Lancet. 2010 May 15;375(9727):1691; author reply 1692 [PMID: 20472164 ] Lancet. 2010 May 15;375(9727):1691-2; author reply 1692 [PMID: 20472165 ]

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