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passages: 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 . 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 .
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entities: Remote ischaemic conditioning
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entities: Remote ischaemic preconditioning
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entities: myocardial salvage
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entities: myocardial salvage .
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entities: myocardial salvage index
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entities: myocardial perfusion imaging
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entities: Median salvage index
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entities: mean salvage index
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entities: Outcome_Adverse-effects
entities: Major adverse coronary events
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entities: death
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entities: reinfarction
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entities: heart failure
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entities: myocardial salvage
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entities: safety
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entities: patients with acute myocardial infarction :
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entities: consecutive adult patients with a suspected first acute myocardial infarction
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entities: patients were excluded on arrival at hospital because they did not meet inclusion criteria ,
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entities: 32
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entities: were lost to follow-up , and
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entities: 77
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entities: did not complete the follow-up