***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Remote ischemic preconditioning reduces myocardial infa rct ion ( MI ) in animal models . We tested the hypothesis that the systemic protection thus induced is effective when ischemic preconditioning is administered during ischemia ( PerC ) and before reperfusion and examined the role of the K(+)-dependent ATP ( K(ATP ) ) channel . Twenty 20-kg pigs were r and omized ( 10 in each group ) to 40 min of left anterior descending coronary artery occlusion with 120 min of reperfusion . PerC consisted of four 5-min cycles of lower limb ischemia by tourniquet during left anterior descending coronary artery occlusion . Left ventricular ( LV ) function was assessed by a conductance catheter and extent of infa rct ion by tetrazolium staining . The extent of MI was significantly reduced by PerC ( 60.4 + /- 14.3 vs. 38.3 + /- 15.4 % , P = 0.004 ) and associated with improved functional indexes . The increase in the time constant of diastolic relaxation was significantly attenuated by PerC compared with control in ischemia and reperfusion ( P = 0.01 and 0.04 , respectively ) . At 120 min of reperfusion , preload-recruitable stroke work declined 38 + /- 6 % and 3 + /- 5 % in control and PerC , respectively ( P = 0.001 ) . The force-frequency relation was significantly depressed at 120 min of reperfusion in both groups , but optimal heart rate was significantly lower in the control group ( P = 0.04 ) . There were fewer malignant arrhythmias with PerC during reperfusion ( P = 0.02 ) . These protective effects of PerC were abolished by glibenclamide . Intermittent limb ischemia during myocardial ischemia reduces MI , preserves global systolic and diastolic function , and protects against arrhythmia during the reperfusion phase through a K(ATP ) channel-dependent mechanism . Underst and ing this process may have important therapeutic implication s for a range of ischemia-reperfusion syndromes 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 OBJECTIVES We sought to relate left ventricular ejection fraction ( EF ) , end-systolic volume index ( ESVI ) and infa rct size ( IS ) , as measured in a single r and omized trial , to six-month mortality  after myocardial infa rct ion ( MI ) treated with thrombolysis .  BACKGROUND These three prognostic indicators have never been compared in the same study group . METHODS Radionuclide angiographic and single-photon emission computed tomographic sestamibi measurements of IS were performed in 1,194 and 1,181 patients , respectively , of the 2,948 patients enrolled in the Collaborative Organization for RheothRx Evaluation ( CORE ) trial .  Ejection fraction , ESVI and IS , as measured by central laboratories in these radionuclide sub studies , were tested for their association with six-month mortality . RESULTS Ejection fraction ( n = 1,137 ; p < 0.0001 ) , ESVI ( n = 945 ; p = 0.055 ) and IS ( n = 1,164 ; p = 0.03 ) were all associated with six-month mortality . Each of these measurements was significantly correlated with the other two , regardless of MI location . In an " overlap " group of 753 patients ( 25.5 % of the population ; 13 deaths ) in whom all three measurements were available , EF ( p = 0.001 ) was a stronger predictor than ESVI ( p = 0.005 ) or IS ( p = 0.01 ) . Neither of the other two measurements added independent prognostic information . The highest risk subgroup ( EF < 30 % ) had an 11 % six-month mortality , but comprised only 95 patients ( 8.3 % ) . CONCLUSIONS Ejection fraction , ESVI and IS measurements performed one to two weeks after MI can each predict six-month mortality . Ejection fraction was superior to the other two measurements . However , this study had limited power to detect independent significance of ESVI or IS BACKGROUND Contrast medium-induced acute kidney injury ( CI-AKI ) is a cardiovascular complication after myocardial infa rct ion treated with emergency percutaneous coronary intervention . The aim of this r and omized , sham-controlled trial was to evaluate the impact of remote ischemic preconditioning ( RIPC ) on CI-AKI in patients with ST-elevation myocardial infa rct ion who received emergency primary percutaneous coronary intervention .  METHODS AND RESULTS Patients with a suspected ST-elevation myocardial infa rct ion were r and omly assigned at a 1:1 ratio to receive percutaneous coronary intervention either with ( n=63 ) or without ( n=62 ) RIPC ( intermittent arm ischemia through three cycles of 5min of inflation and 5min of deflation of a blood pressure cuff ) . A total of 47 RIPC patients and 47 control patients met all study criteria . The primary endpoint was the incidence of CI-AKI , which was defined as an increase in serum creatinine > 0.5mg/dL or > 25 % over the baseline value 48 - 72h after administration of contrast medium . The incidence of CI-AKI was 10 % ( n=5 ) in the RIPC group and 36 % ( n=17 ) in the control group ( p=0.003 ) . The odds ratio of CI-AKI in patients who received RIPC was 0.18 ( 95 % confidence interval : 0.05 - 0.64 ; p=0.008 ) . CONCLUSIONS In patients with ST-elevation myocardial infa rct ion , RIPC before percutaneous coronary intervention reduced the incidence of CI-AKI Introduction Myocardial injury after percutaneous coronary intervention ( PCI ) occurs in approximately 30 % of procedures , and is related to worse prognosis . Effects of remote ischemic preconditioning ( RIPC ) on reperfusion injury have been investigated before , yielding conflicting results . Aim To assess the impact of a single episode of RIPC on myocardial injury after elective PCI . Material and methods One hundred and four patients undergoing elective PCI , with normal baseline cardiac troponin-I ( cTn-I ) values , were r and omized to two groups . Two patients were excluded due to data loss , and 102 patients were analyzed .  Five minutes of ischemic preconditioning was delivered just before the intervention to the preconditioning group , by inflating the blood pressure cuff up to 200 mm Hg on the non-dominant arm . Postprocedural 16th hour cTn-I , ΔcTn-I ( difference between the 16th h and baseline cTn-I values ) and the prevalence of type 4a myocardial infa rct ion were compared between the two groups . Results Median cTn-I values after the procedure were compared . 16th hour cTn-I was insignificantly lower in the preconditioning arm ( 0.026 μg/l vs. 0.045 μg/l , p = 0.186 ) . The incidence of cTn-I elevation 5-fold above the upper reference limit ( URL ) ( > 0.115 μg/l ) was lower in the preconditioning group , but it was also not significant ( 21.6 % vs. 11.8 % , p = 0.184 ) . Conclusions A single episode of RIPC before elective PCI demonstrated less troponin elevation but failed to show a significant effect Background Remote ischemic postconditioning ( RIPC ) is suggested to protect the myocardium against ischemia in various setting s. However , the effect of RIPC in patients with acute ST-elevation myocardial infa rct ion ( STEMI ) who undergo thrombolysis has yet to be examined . Patients and methods In this single-center , r and omized controlled trial , we examined the effect of RIPC on the resolution of ST-segment elevation ( STR ) in response to thrombolysis . Patients in the RIPC group had three cycles of 5‑min cuff inflation followed by 5‑min deflation to the upper arm . Results The study comprised 78 patients ( 15 women ) , of whom 41 were r and omized to the RIPC group and 37 to the control group . STR occurred in 61 % of the patients in the RIPC group , while it was detected only in 35 % of controls ( p = 0.026 ) . Although STR was more common in the RIPC group , there was no difference in the extent of ΣCK-48 h between the two groups . Furthermore , the length of hospital stay and the frequency of adverse events were similar between the RIPC and control groups . Conclusion RIPC during thrombolytic therapy in STEMI was associated with a higher frequency of STR . However , it did not affect enzymatic infa rct size or the frequency of adverse events . ( Clinical trial registration number : I RCT 2014011916229N2.)ZusammenfassungHintergrundDie indirekte ischämische Postkonditionierung ( „ remote ischemic postconditioning “ , RIPC ) soll das Myokard gegen Ischämie in verschiedenen Situationen schützen . Die Wirksamkeit der RIPC bei Patienten mit akutem ST-Strecken-Hebungs-Infarkt ( STEMI ) , bei denen eine Thrombolyse erfolgt , muss allerdings noch untersucht werden . Patienten und Method enIn der vorliegenden r and omisierten kontrollierten Einzelzentrumsstudie wurde die Wirksamkeit des RIPC auf die Rückbildung der ST-Strecken-Hebung ( STR ) als Reaktion auf die Thrombolyse untersucht . Patienten in der RIPC-Gruppe hatten 3 Zyklen mit 5‑minütigem Aufpumpen der Manschette und anschließendem 5‑minütigem Ablassen der Manschette am Oberarm . ErgebnisseAn der Studie nahmen 78 Patienten ( davon 15 Frauen ) teil , von denen 41 r and omisiert der RIPC-Gruppe und 37 der Kontrollgruppe zugeteilt wurden . Eine STR trat bei 61 % der Patienten in der RIPC-Gruppe auf , aber nur bei 35 % der Kontrollen ( p = 0,026 ) . Zwar gab es eine STR häufiger in der RIPC-Gruppe , aber es best and kein Unterschied i m Ausmaß von ΣCK-48 h zwischen den beiden Gruppen . Darüber hinaus waren die Verweildauer und die Häufigkeit unerwünschter Ereignisse zwischen der RIPC- und der Kontrollgruppe ähnlich . SchlussfolgerungEine RIPC während der Thromobolysetherapie bei STEMI ging mit größerer Häufigkeit einer STR einher . Sie hatte jedoch keine Auswirkung auf die enzymatische Infarktgröße oder die Häufigkeit unerwünschter Ereignisse . ( Nummer i m Register klinischer Studien , „ clinical trial registration number “ : I 
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Conclusions : Despite a statistically significant reduction of myocardial damage in STEMI patients , the magnitude of the reduction was small and a significant impact on clinical events is unlikely .
With respect to elective percutaneous coronary intervention , remote ischaemic conditioning had no influence on myocardial injury and its use is not supported by our analysis