期刊
BASIC RESEARCH IN CARDIOLOGY
卷 113, 期 3, 页码 -出版社
SPRINGER HEIDELBERG
DOI: 10.1007/s00395-018-0672-3
关键词
ST-elevation myocardial infarction; Remote ischaemic conditioning; Heart failure; Randomized controlled trial; Left ventricular function
资金
- Portuguese Foundation for Science and Technology through the Cardiovascular RD Unit [PEst-C/SAU/UI0051/2011, EXCL/BIM-MEC/0055/2012]
- European Commission Grant FP7-Health [MEDIA261, 409]
- Project DOCnet [NORTE-01-0145-FEDER-000003]
- Norte Portugal Regional Operational Programme (NORTE) under the PORTUGAL Partnership Agreement, through the European Regional Development Fund (ERDF)
- European Structural and Investment Funds (ESIF), under Lisbon Portugal Regional Operational Programme
- National Funds through Foundation for Science and Technology [POCI-01-0145FEDER-016385]
- Jose de Mello Saude
- Fundação para a Ciência e a Tecnologia [PEst-C/SAU/UI0051/2011] Funding Source: FCT
To test whether remote ischaemic conditioning (RIC) as adjuvant to standard of care (SOC) would prevent progression towards heart failure (HF) after ST-elevation myocardial infarction (STEMI). Single-centre parallel 1: 1 randomized trial (computerized block-randomization, concealed allocation) to assess superiority of RIC (3 cycles of intermittent 5 min lower limb ischaemia) over SOC in consecutive STEMI patients (NCT02313961, clinical trials. gov). From 258 patients randomized to RIC or SOC, 9 and 4% were excluded because of unconfirmed diagnosis and previously unrecognized exclusion criteria, respectively. Combined primary outcome of cardiac mortality and hospitalization for HF was reduced in RIC compared with SOC (n = 231 and 217, respectively; HR = 0.35, 95% CI 0.15-0.78) as well as each outcome in isolation. No difference was found in serum troponin I levels between groups. Median and maximum follow-up time were 2.1 and 3.7 years, respectively. In-hospital HF (RR = 0.68, 95% CI 0.47-0.98), need for diuretics (RR = 0.68, 95% CI 0.48-0.97) and inotropes and/or intra-aortic balloon pump (RR = 0.17, 95% CI 0.04-0.76) were decreased in RIC. On planned 12 months follow-up echocardiography (n = 193 and 173 in RIC and SOC, respectively) ejection fraction (EF) recovery was enhanced in patients presenting with impaired left ventricular (LV) function (10% absolute difference in median EF compared with SOC; P < 0.001). In addition to previously reported improved myocardial salvage index and reduced infarct size RIC was shown beneficial in a combined hard clinical endpoint of cardiac mortality and hospitalization for HF. Improved EF recovery was also documented in patients with impaired LV function.
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