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Randomized Controlled Trial
. 2015 Nov 21;36(44):3049-57.
doi: 10.1093/eurheartj/ehv463. Epub 2015 Sep 17.

Cardioprotection by combined intrahospital remote ischaemic perconditioning and postconditioning in ST-elevation myocardial infarction: the randomized LIPSIA CONDITIONING trial

Ingo Eitel  1 , Thomas Stiermaier  2 , Karl P Rommel  2 , Georg Fuernau  3 , Marcus Sandri  2 , Norman Mangner  2 , Axel Linke  2 , Sandra Erbs  2 , Phillip Lurz  2 , Enno Boudriot  2 , Meinhard Mende  4 , Steffen Desch  3 , Gerhard Schuler  2 , Holger Thiele  3
Affiliations
Randomized Controlled Trial

Cardioprotection by combined intrahospital remote ischaemic perconditioning and postconditioning in ST-elevation myocardial infarction: the randomized LIPSIA CONDITIONING trial

Ingo Eitel et al. Eur Heart J. .

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.

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