***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: OBJECTIVES This study sought to evaluate whether remote ischemic post-conditioning ( RIPC ) could reduce enzymatic infa rct size in patients with anterior ST-segment elevation myocardial infa rct ion undergoing primary percutaneous coronary intervention ( pPCI ) . BACKGROUND Myocardial reperfusion injury may attenuate the benefit of pPCI . In animal models , RIPC mitigates myocardial reperfusion injury . METHODS One hundred patients with anterior ST-segment elevation myocardial infa rct ion and occluded left anterior descending artery were r and omized to pPCI + RIPC  ( n = 50 ) or conventional pPCI ( n = 50 ) . RIPC consisted of 3 cycles of 5 min/5 min ischemia/reperfusion by cuff inflation/deflation of the lower limb . The primary endpoint was infa rct size assessed by the area under the curve of creatinine kinase-myocardial b and release ( CK-MB ) . Secondary endpoints included the following : infa rct size assessed by cardiac magnetic resonance delayed enhancement volume ; T2-weighted edema volume ; ST-segment resolution > 50 % ; TIMI ( Thrombolysis In Myocardial Infa rct ion ) frame count ; and myocardial blush grading . RESULTS Four patients ( 2 RIPC , 2 controls ) were excluded due to missing sample s of CK-MB . A total of 96 patients were analyzed ; median area under the curve CK-MB was 8,814 ( interquartile range [ IQR ] : 5,567 to 11,325 ) arbitrary units in the RIPC group and 10,065 ( IQR : 7,465 to 14,004 ) arbitrary units in control subjects ( relative reduction : 20 % , 95 % confidence interval : 0.2 % to 28.7 % ; p = 0.043 ) . Seventy-seven patients underwent a cardiac magnetic resonance scan 3 to 5 days after r and omization , and 66 patients repeated a second scan after 4 months . T2-weighted edema volume was 37 ± 16 cc in RIPC patients and 47 ± 22 cc in control subjects ( p = 0.049 ) . ST-segment resolution > 50 % was 66 % in RIPC and 37 % in control subjects ( p = 0.015 ) . We observed no significant differences in TIMI frame count , myocardial blush grading , and delayed enhancement volume . CONCLUSIONS In patients with anterior ST-segment elevation myocardial infa rct ion , RIPC at the time of pPCI reduced enzymatic infa rct size and was also associated with an improvement of T2-weighted edema volume and ST-segment resolution > 50 % . ( Remote Postconditioning in Patients With Acute Myocardial Infa rct ion Treated by Primary Percutaneous Coronary Intervention [ PCI ] [ RemPostCon ] ; NCT00865722 ) 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 infa rct ion , and done before primary percutaneous coronary intervention , increases myocardial salvage . METHODS 333 consecutive adult patients with a suspected first acute myocardial infa rct ion were r and omly assigned in a 1:1 ratio by computerised block r and omisation 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 Clinical Trials.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 ) , reinfa rct ion ( 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 Background Reduction of infa rct size by ischemic postconditioning ( IPost ) has been reported in smaller proof‐of‐concept clinical studies , but has not been confirmed in other smaller studies . The principle needs to be evaluated in larger groups of ST‐elevation myocardial infa rct ion ( STEMI ) patients before being implemented in clinical practice . This study assessed the effect of ischemic postcoditioning ( IPost ) on infa rct size in patients with STEMI treated by primary percutaneous coronary intervention ( PCI ) . Methods and Results Patients with first‐time STEMI , < 6 hours from symptom onset , referred to primary PCI were r and omized to IPost or control groups . IPost was administered by 4 cycles of 1‐minute reocclusion and 1‐minute reperfusion , starting 1 minute after opening , followed by stenting . In the control group , stenting was performed immediately after reperfusion . The primary endpoint was infa rct size measured by cardiac magnetic resonance after 4 months . A total of 272 patients were r and omized . Infa rct size ( percent of left ventricular mass ) after 4 months ( median values and interquartile range ) was 14.4 % ( 7.7 , 24.6 ) and 13.5 % ( 8.1 , 19.3 ) in the control group and IPost group , respectively ( P=0.18 ) . No significant impact of IPost was found when controlling for baseline risk factors of infa rct size in a multivariate linear regression model ( P=0.16 ) . The effects of IPost on secondary endpoints , including markers of necrosis , myocardial salvage , and ejection fraction , as well as adverse cardiac events during follow‐up , were consistently neutral . Conclusions In contrast to several smaller trials reported previously , we found no significant effects of IPost on infa rct size or secondary study outcomes . Clinical Trial Registration URL : http://www . clinical trials.gov Unique identifier : NCT.No . PO1506 OBJECTIVES The second Primary Angioplasty in Myocardial Infa rct ion ( PAMI-II ) study evaluated the hypothesis that primary percutaneous transluminal coronary angioplasty ( PTCA ) , with subsequent discharge from the hospital 3 days later , is safe and cost-effective in low risk patients . BACKGROUND In low risk patients with myocardial infa rct ion ( MI ) , few data exist regarding the need for intensive care and noninvasive testing or the appropriate length of hospital stay . METHODS Patients with acute MI underwent emergency catheterization with primary PTCA  when appropriate . Low risk patients ( age < 70 years , left ventricular ejection fraction > 45 % , one- or two-vessel disease , successful PTCA , no persistent arrhythmias ) were r and omized to receive accelerated care ( admission to a nonintensive care unit and day 3 hospital discharge without noninvasive testing [ n = 237 ] or traditional care [ n = 234 ] ) . RESULTS Patients who received accelerated care had similar in-hospital outcomes but were discharged 3 days earlier ( 4.2+/-2.3 vs. 7.1+/-4.7 days , p = 0.0001 ) and had lower hospital costs ( $ 9,658+/-5,287 vs. $ 11,604+/-6,125 p = 0.002 ) than the patients who received traditional care . At 6 months , accelerated and traditional care groups had a similar rate of mortality ( 0.8 % vs. 0.4 % , p = 1.00 ) , unstable ischemia ( 10.1 % vs. 12.0 % , p = 0.52 ) , reinfa rct ion ( 0.8 % vs. 0.4 % , p = 1.00 ) , stroke ( 0.4 % vs. 2.6 % , p = 0.07 ) , congestive heart failure ( 4.6 % vs. 4.3 % , p = 0.85 ) or their combined occurrence ( 15.2 % vs. 17.5 % , p = 0.49 ) . The study was design ed to detect a 10 % difference in event rates ; at 6 months , only a 2.3 % difference was measured between groups , indicating an actual power of 0.19 . CONCLUSIONS Early identification of low risk patients with MI allowed safe omission of the intensive care phase and noninvasive testing , and a day 3 hospital discharge strategy , result ing in substantial cost savings Background Ischemic postconditioning ( PostC ) , reperfusion in brief cycles , is known to induce short-term reduction in infa rct size in patients with ST elevation myocardial infa rct ion ( STEMI ) , especially among those with large myocardium at risk ( MaR ) . The aim of the present study was to investigate the long-term effect of PostC on infa rct size and left ventricular ejection fraction ( LVEF ) . Methods Sixty-eight patients with a first STEMI were r and omised to primary percutaneous coronary intervention ( PCI ) ( n = 35 ) or PCI followed by PostC ( n = 33 ) . MaR was determined as abnormally contracting segments on left ventricular angiogram . Cardiac magnetic resonance was performed at 3 and 12 months for the determination of infa rct size and LVEF . Results Overall there was no difference in infa rct size expressed in percentage of MaR between patients r and omised to the control ( 31 % ; 23 , 41 ) and PostC ( 31 % ; 23 , 43 ) groups at 12 months . Likewise there was no difference in LVEF between control ( 49 % ; 41 , 55 ) and PostC ( 52 % ; 45 , 55 ) . In contrast , patients in the PostC group with MaR in the upper quartile had a significantly smaller infa rct size ( 29 % ; 18 , 38 ) than those in the control group ( 40 % ; 34 , 48 ; p < 0.05 ) at 12 months . In these patients LVEF was higher in the PostC ( 47 % ; 43 , 50 ) compared to the control group ( 38 % ; 34 , 42 ; p < 0.01 ) . Conclusions In this long-term follow-up study PostC did not reduce infa rct size in relation to MaR or improved LVEF in the overall study population . However , the present data suggest that PostC exerts long-term beneficial effects in patients with large MaR thereby extending previously published short-term observations . Trial registration Karolinska Clinical Trial Registration ( http://www.kctr.se ) . Unique identifier : Background — Myocardial necrosis can occur during  percutaneous coronary intervention ( PCI )  despite optimal adjunctive pharmacology and careful technique . We investigated the mechanisms of procedural infa rct ion using angiographic analysis , intravascular ultrasound , and delayed-enhancement magnetic resonance imaging . Methods and Results — Fifty-two patients ( 64 vessels ) who underwent complex PCI were studied . All patients were preloaded with clopidogrel and received glycoprotein IIb/IIIa inhibitors . “ Adjacent ” myonecrosis was defined as the presence of an area of new gadolinium hyperenhancement close to the stent . “ Distal ” myonecrosis was defined as situated at least 10 mm downstream from the stent . Fifteen vessels ( 23 % ) had evidence of new hyperenhancement after PCI . Of these , 8 ( 12 % ) had the distal type , and 7 ( 11 % ) had the adjacent type . Intravascular ultrasound showed a significantly greater reduction in plaque volume ( 91.6±51.5 versus 8±14 versus 20±35 mm3 ; P<0.001 ) in the group with distal hyperenhancement compared with patients without new hyperenhancement or adjacent hyperenhancement . In the entire sample , a significant correlation was seen between changes in plaque volume ( & rgr;=0.58 , P<0.001 ) after PCI and the mass of new necrosis measured by magnetic resonance imaging . Thrombolysis in Myocardial 
    Output:
    
RIPreC and LIPostC improve myocardial salvage index and myocardial infa rct size respectively in PCI for STEMI .
No mortality benefit detected with RIPreC in elective PCI