Daily remote ischaemic conditioning following acute myocardial infarction: a randomised controlled trial

Heart. 2018 Dec;104(23):1955-1962. doi: 10.1136/heartjnl-2018-313091. Epub 2018 May 10.


Background: Remote ischaemic conditioning (rIC) is a cardioprotective tool which has shown promise in preclinical and clinical trials in the context of acute ischaemia. Repeated rIC post myocardial infarction may provide additional benefits which have not previously been tested clinically.

Methods: The trial assessed the role of daily rIC in enhancing left ventricular ejection fraction (LVEF) recovery in patients with impaired LVEF (<45%) after ST segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (P-PCI). Patients were recruited from four UK hospitals and randomised to receive either 4 weeks of daily rIC or sham conditioning using the autoRIC Device (CellAegis) starting on day 3 post P-PCI. The primary endpoint was the improvement in LVEF over 4 months assessed by cardiac MRI (CMR). Seventy-three patients (38 cases, 35 controls) completed the study.

Results: The treatment and control groups were well matched at baseline including for mean LVEF (42.8% vs 44.3% respectively, p=0.952). There was no difference in the improvement in LVEF over 4 months between the treatment and control groups (4.8%±7.8% vs 4.6%±5.9% respectively, p=0.924). No differences were seen in the secondary outcome measures including changes in infarct size and left ventricular end-diastolic and systolic volumes, major adverse cardiac and cerebral event, mean Kansas City Cardiomyopathy Questionnaire score and change in N-terminal pro-brain natriuretic peptide levels.

Conclusions: Daily rIC starting on day 3 and continued for 4 weeks following successful P-PCI for STEMI did not improve LVEF as assessed by CMR after 4 months when compared with a matched control group.

Trial registration number: NCT0166461.

Trial registration: ClinicalTrials.gov NCT01664611.

Keywords: ST elevation myocardial infarction; heart failure; primary percutaneous coronary intervention; remote ischaemic conditioning; ventricular remodelling.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Female
  • Hemodynamic Monitoring / methods
  • Humans
  • Ischemic Preconditioning, Myocardial / methods*
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / analysis
  • Outcome Assessment, Health Care
  • Peptide Fragments / analysis
  • Percutaneous Coronary Intervention* / adverse effects
  • Percutaneous Coronary Intervention* / methods
  • Postoperative Complications / prevention & control*
  • ST Elevation Myocardial Infarction* / physiopathology
  • ST Elevation Myocardial Infarction* / therapy
  • Stroke Volume
  • Ventricular Dysfunction, Left* / etiology
  • Ventricular Dysfunction, Left* / prevention & control


  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain

Associated data

  • ClinicalTrials.gov/NCT01664611