***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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    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 — In animal models , brief periods of ischemia performed just at the time of reperfusion can reduce infa rct size , a phenomenon called postconditioning . In this prospect i ve , r and omized , controlled , multicenter study , we investigated whether postconditioning may protect the human heart during coronary angioplasty for acute myocardial infa rct ion . Methods and Results — Thirty patients , su bmi tted to coronary angioplasty for ongoing acute myocardial infa rct ion , contributed to the study . Patients were r and omly assigned to either a control or a postconditioning group . After reperfusion by direct stenting , control subjects underwent no further intervention , whereas postconditioning was performed within 1 minute of reflow by 4 episodes of 1-minute inflation and 1-minute deflation of the angioplasty balloon . Infa rct size was assessed by measuring total creatine kinase release over 72 hours . Area at risk and collateral blood flow were estimated on left ventricular and coronary angiograms . No adverse events occurred in the postconditioning group . Determinants of infa rct size , including ischemia time , size of the area at risk , and collateral flow , were comparable between the 2 groups . Area under the curve of creatine kinase release was significantly reduced in the postconditioning compared with the control group , averaging 208 984±26 576 compared with 326 095±48 779 ( arbitrary units ) in control subjects , ie , a 36 % reduction in infa rct size . Blush grade , a marker of myocardial reperfusion , was significantly increased in postconditioned compared with control subjects : 2.44±0.17 versus 1.95±0.27 , respectively ( P<0.05 ) . Conclusions — This study suggests that postconditioning by coronary angioplasty protects the human heart during acute myocardial infa rct ion Remote ischemic conditioning ( RIC ) is known to improve microcirculation in various setting s , but little is known about the impact of the amount of ischemic tissue mass or the limb itself . Since ischemia and subsequent necrosis of flaps is one of the most dreaded complications in reconstructive surgery , adjuvant methods to improve microcirculation are desirable . We therefore performed a r and omized trial to compare the effect of arm versus leg ischemia for RIC of the cutaneous microcirculation of the antero-lateral thigh . Forty healthy volunteers were r and omized to undergo 5 min of ischemia of either the upper or lower extremity , followed by 10 min of reperfusion . Ischemia was induced by a surgical tourniquet applied to the proximal limb , which was inflated to 250 mmHg for the upper and 300 mgHg for the lower extremity . This cycle was repeated a total of three times . Cutaneous microcirculation was assessed by combined laser doppler spectrophotometry on the antero-lateral aspect of the thigh to measure cutaneous blood flow ( BF ) , relative hemoglobin content ( rHb ) , and oxygen saturation ( StO2 ) . Baseline measurements were performed for 10 min , after which the ischemia/reperfusion cycles were begun . Measurements were performed continuously and were afterwards pooled to obtain a mean value per minute . Both groups showed significant increases in all three measured parameters of cutaneous microcirculation after three cycles of ischemia/reperfusion when compared to baseline ( BF : 95.1 % ( P < 0.001 ) and 27.9 % ( P = 0.002 ) ; rHb : 9.4 % ( P < 0.001 ) and 5.9 % ( P < 0.001 ) , StO2 : 8.4 % ( P = 0.045 ) and 9.4 % ( P < 0.001 ) . When comparing both groups , BF was significantly higher in the arm group ( P = 0.019 after 11 min . , P = 0.009 after 45 min ) . In conclusions , both ischemic conditioning of the upper and lower extremity is able to improve cutaneous BF on the ALT donor site . However , RIC of the upper extremity seems to be a superior trigger for improvement of cutaneous BF 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 Background The aim of this study was to evaluate the role of remote ischemic postconditioning ( RIPC ) of the upper arm on protection from cardiac ischemia-reperfusion injury following primary percutaneous coronary intervention ( PCI ) in patients with acute ST-segment elevation myocardial infa rct ion ( STEMI ) . Material / Methods Eighty patients with STEMI were r and omized into two groups : primary PCI ( N=44 ) and primary PCI+RIPC ( N=36 ) . RIPC consisted of four cycles of 5 minutes of occlusion and five minutes of reperfusion by cuff inflation and deflation of the upper arm , commencing within one minute of the first PCI balloon dilatation . Peripheral venous blood sample s were collected before PCI and at 0.5 , 8 , 24 , 48 , and 72 hours after PCI . Levels of creatine kinase-MB ( CK-MB ) , serum creatinine ( Cr ) , nitric oxide ( NO ) , and stromal cell-derived factor-1α ( SDF-1α ) were measured . The rates of acute kidney injury ( AKI ) and the estimated glomerular filtration rate ( eGFR ) were calculated . Results Patients in the primary PCI+RIPC group , compared with the primary PCI group , had significantly lower peak CK-MB concentrations ( P<0.01 ) , a significantly increased left ventricular ejection fraction ( LVEF ) ( P=0.01 ) , a significantly lower rate of AKI ( P<0.01 ) a significantly increased eGFR ( P<0.01 ) , and decreased area under the curve ( AUC ) of CK-MB , NO and SDF-1α . Conclusions RIPC of the upper arm following primary PCI in patients with acute STEMI might provide cardiac and renal protection from ischemia-reperfusion injury via the actions of SDF-1α , and NO Importance Ischemic postconditioning of the heart during primary percutaneous coronary intervention ( PCI ) induced by repetitive interruptions of blood flow to the ischemic myocardial region immediately after reopening of the infa rct -related artery may limit myocardial damage . Objective To determine whether 
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Conclusion RIC was associated with lower myocardial edema levels , myocardial salvage index and incidence of MACCE , while non-significant beneficial effect on infa rct size , TIMI flow grade III or LVEF .
These findings suggest that RIC is a promising adjunctive treatment to PCI for the prevention of reperfusion injury in STEMI patients