Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial
Author
Hausenloy, Derek
Kharbanda, Rajesh
Møller, Ulla Kristine
Ramlall, Manish
Aarøe, Jens
Butler, Robert
Bulluck, Heerajnarain
Clayton, Tim
Dana, Ali
Dodd, Matthew
Engstrom, Thomas
Evans, Richard
Lassen, Jens Flensted
Christensen, Erika
Garcia-Ruiz, José Manuel
Gorog, Diana
Hjort, Jakob
Houghton , Richard
Ibanez, Borja
Knight, Rosemary
Lippert, Freddy K
Lønborg, Jacob
Maeng, Michael
Milasinovic, Dejan
More, Ranjit
Nicholas, Jennifer M
Jensen, Lisette O
Perkins, Alexander
Radovanovic, Nebojsa
Rakhit, Roby
Ravkilde, Jan
Ryding, Alisdair D
Schmidt, Michael R
Riddervold, Ingun S
Sørensen,, Henrik T
Stankovic, Goran
Varma, Madhusudhan
Webb, Ian
Terkelsen, Christian J
Greenwood, John
Yellon, Derek
Bøtker†, Hans E
Attention
2299/21675
Abstract
Background: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. Methods: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. Findings: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91–1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. Interpretation: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. Funding: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden.