Cardioprotection by Combined Intrahospital Remote Ischaemic Perconditioning and Postconditioning in ST-elevation Myocardial Infarction: The Randomized LIPSIA CONDITIONING Trial

Eur Heart J. 2015 Nov 21;36(44):3049-57. doi: 10.1093/eurheartj/ehv463. Epub 2015 Sep 17.

Abstract

Aims: Remote ischaemic conditioning (RIC) and postconditioning (PostC) are both potent activators of innate protection against ischaemia-reperfusion injury and have demonstrated cardioprotection in experimental and clinical ST-elevation myocardial infarction (STEMI) trials. However, their combined effects have not been studied in detail. The aim of this study was to evaluate if the co-application of intrahospital RIC and PostC has a more powerful effect on myocardial salvage compared with either PostC alone or control.

Methods and results: This prospective, controlled, single-centre study randomized 696 STEMI patients to one of the following three groups: (i) combined intrahospital RIC + PostC in addition to primary percutaneous coronary intervention (PCI); (ii) PostC in addition to PCI; and (iii) conventional PCI (control). The primary endpoint myocardial salvage index was assessed by cardiac magnetic resonance (CMR) imaging within 3 days after infarction. Secondary endpoints included infarct size and microvascular obstruction (MVO) assessed by CMR. The combined clinical endpoint consisted of death, reinfarction, and new congestive heart failure within 6 months. The primary endpoint myocardial salvage index was significantly greater in the combined RIC + PostC group when compared with the control group (49 [interquartile range 30-72] vs. 40 [interquartile range 16-68], P = 0.02). Postconditioning alone failed to improve myocardial salvage when compared with conventional PCI (P = 0.39). The secondary endpoints, including infarct size and MVO, showed no significant differences between groups. Clinical follow-up at 6 months revealed no differences in the combined clinical endpoint between groups (P = 0.44).

Conclusion: Combined intrahospital RIC + PostC in conjunction with PCI in STEMI significantly improves myocardial salvage in comparison with control and PostC.

Clinicaltrialsgov: NCT02158468.

Keywords: Cardioprotection; Myocardial salvage; Postconditioning; Remote ischaemic conditioning.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Biomarkers / metabolism
  • Combined Modality Therapy / methods
  • Female
  • Hospitalization
  • Humans
  • Ischemic Postconditioning / methods*
  • Ischemic Preconditioning, Myocardial / methods*
  • Magnetic Resonance Angiography
  • Male
  • Middle Aged
  • Myocardial Infarction / therapy*
  • Myocardial Reperfusion Injury / prevention & control*
  • Prospective Studies
  • Remote Consultation
  • Treatment Outcome

Substances

  • Biomarkers

Associated data

  • ClinicalTrials.gov/NCT02158468