Table 1.
Major clinical studies of RIC in STEMI
| Study and Year | Number of patients | Type of patients | RIC protocol | Main outcomes | Notes |
|---|---|---|---|---|---|
| Bøtker et al. (Botker HE, Kharbanda R, 2010b) CONDI (2010) |
142 | All STEMI | 4 × 5 min inflations/deflations of cuff on upper arm in the ambulance before PPCI Sham control: none |
Primary endpoint: Myocardial salvage index at 30 days post PPCI, measured by myocardial perfusion imaging as the proportion of the area at risk salvaged by treatment Increase in myocardial salvage index at 30 days No difference in MI size (SPECT or peak troponin) |
First study to test effect of RIC in patients with STEMI Reduced MI size in LAD STEMI |
| Munk et al. (Munk et al., 2010) (2010) |
242 | All STEMI | 4 × 5 min inflations/deflations of cuff on upper arm in the ambulance before PPCI Sham control: none |
Ejection fraction, LV volumes (2D and 3D echocardiography and myocardial perfusion imaging), and speckle-tracking global longitudinal strain were compared between treatment groups. Although no significant overall effect was observed, RIC seemed to result in modest improvement in LV function in high-risk patients prone to develop large myocardial infarcts |
The effect of RIC was analysed in relation to the size of the myocardial area at risk (AAR), infarct location, and target vessel patency. |
| Rentoukas et al (Rentoukas I, Giannopoulos G, 2010b) (2010) |
93 | All STEMI | 3 × 4 min inflations/deflations of cuff on upper arm at the hospital before PPCI Sham control: 3 × 5 min low-pressure inflations/deflations |
Better ST-segment resolution and lower peak troponin I Additive effects with morphine |
Combined effects of RIC with morphine |
| Crimi et al. (Crimi et al., 2013) (2013) |
100 | Anterior STEMI only | 3 × 5 min inflations/deflation of cuff on thigh at onset of reperfusion Sham control: none |
20% reduction in 72 h AUC CK–MB 21% reduction in myocardial oedema by MRI |
First study to show effect of RIC given at onset of reperfusion, and first to report effect of RIC on enzymatic MI size and myocardial oedema |
| Sloth et al. (Sloth et al., 2014) (2014) |
251 | All STEMI | 4 × 5 min inflations/deflations of cuff on upper arm in the ambulance before PPCI Sham control: none |
51% reduction in all-cause mortality, nonfatal MI, TIA or stroke, HHF at 3.8 years | First study to test effect of RIC on long-term outcomes after PPCI (secondary end point) |
| Prunier et al. (Prunier et al., 2014) (2014) |
55 | All STEMI | 3 × 5 min inflations/deflations of cuff on upper arm in before PPCI Sham control: none |
RIC immediately prior to PPCI was shown to reduce infarct size in STEMI patients, yet combining this therapy with an IPost strategy did not lead to further decrease in infarct size. | Study had arm involving PPCI combined with RIC and IPost which consisted of four cycles of 1-min inflation and 1-min deflation of the angioplasty balloon. |
| White et al. (White et al., 2015) ERIC-STEMI (2015) |
83 | All STEMI | 4 × 5 min inflations/deflations of cuff on upper arm at the hospital before PPCI Sham control: deflated cuff |
27% reduction in MI size by MRI 19% reduction in myocardial oedema by MRI |
First study to show effect of RIC given before PPCI on MI size and myocardial oedema by MRI |
| Yellon et al. (Yellon et al., 2015) ERIC-LYSIS (2015) |
519 | All STEMI | 4 × 5 min inflations/deflations of cuff on upper arm at the hospital before thrombolysis Sham control: deflated cuff |
17% reduction in enzymatic MI size (CK–MB and troponin T) | Only study to test effect of RIC in thrombolysed patients with STEMI |
| Eitel et al. (Eitel et al., 2015) LIPSIA CONDITIONING (2015) |
333 | All STEMI | 4 × 5 min inflations/deflations of cuff on upper arm at the hospital before PPCI plus IPost Sham control: none |
Increased myocardial salvage with RIC + IPost versus control (49 versus 40) No difference in MI size, MVO, or 6-month clinical end points (death, reinfarction, and heart failure at 6 months) |
Improved myocardial salvage when IPost combined with RIC Neither IPost alone nor RIC + IPost reduce myocardial oedema |
| Yamanaka et al. (Yamanaka et al., 2015) (2015) |
94 | All STEMI | 3 × 5 min inflations/deflations of cuff on upper arm at the hospital before PPCI Sham control: Yes |
Primary endpoint: Incidence of contrast induced-AKI after administration of contrast medium Odds ratio of CI-AKI in patients who received RIPC was 0.18 (95% confidence interval: 0.05-0.64; p=0.008) |
Lower incidence of ventricular arrhythmia was noted in the RIC group within 24 hours of RIC |
| Verouhis et al. (Verouhis et al., 2016) (2016) |
93 | Anterior STEMI only | 5-minute cycles of inflation and deflation of a blood pressure cuff around the left thigh which was continued throughout the PCI procedure Sham control: Yes |
The primary endpoint of the study was infarct size e×pressed as myocardial salvage inde× determined by CMR on days 4-7 after PCI. There was no significant difference in myocardial salvage inde× between the RIPerC and PCI group |
This study has been the only neutral study RIC STEMI study. The use of a non-standard RIC protocol comprising variable numbers of RIC cycles (as many as 7-9) were used and may have contributed to the neutral results. |
| Liu et al. (Liu et al., 2016) (2016) |
119 | All STEMI | 4 × 5 min inflations to 200 mmHg /deflations of cuff on upper arm in the ambulance before PPCI Sham control: none |
The primary study end point was early microvascular obstruction measured by CMR. There was a significant decrease in early microvascular obstruction as assessed by CMR in the RIC group |
This was the first study to assess the effect of RIC in STEMI patients through the use of CMR to detect early microvascular obstruction. |
| Gaspar et al. (Gaspar et al., 2018) (2018) |
448 | All STEMI | 3 × 5 min inflations/deflations of cuff on upper arm in before PPCI Sham control: Yes |
RIC was shown to be beneficial in a combined clinical endpoint of cardiac mortality and hospitalisation for HF. Improved EF recovery was also documented in patients with impaired LV function. In-hospital heart failure risk and need for diuretics, inotropes and/or intraaortic balloon pump were reduced in RIC group | First prospectively designed study to investigate the effect of RIC on clinical outcomes following STEMI as primary endpoint. |
| CONDI-2/ERIC-PPCI (Hausenloy et al., 2015b) | 5,400 | All STEMI | 4 × 5 min inflations/deflations of cuff on upper arm before PPCI Sham control: none or simulated |
Ongoing study Primary end point of cardiac death and HHF at 12 months |
Collaboration between Denmark, Serbia, Spain, and the UK First study to test effect of RIC on long-term clinical outcomes as primary end point |