Department of Cardiology, Hospital de Braga, Braga, Portugal.
Department of Surgery and Physiology, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
Basic Res Cardiol. 2018 Mar 7;113(3):14. doi: 10.1007/s00395-018-0672-3.
To test whether remote ischaemic conditioning (RIC) as adjuvant to standard of care (SOC) would prevent progression towards heart failure (HF) after ST-elevation myocardial infarction (STEMI). Single-centre parallel 1:1 randomized trial (computerized block-randomization, concealed allocation) to assess superiority of RIC (3 cycles of intermittent 5 min lower limb ischaemia) over SOC in consecutive STEMI patients (NCT02313961, clinical trials.gov). From 258 patients randomized to RIC or SOC, 9 and 4% were excluded because of unconfirmed diagnosis and previously unrecognized exclusion criteria, respectively. Combined primary outcome of cardiac mortality and hospitalization for HF was reduced in RIC compared with SOC (n = 231 and 217, respectively; HR = 0.35, 95% CI 0.15-0.78) as well as each outcome in isolation. No difference was found in serum troponin I levels between groups. Median and maximum follow-up time were 2.1 and 3.7 years, respectively. In-hospital HF (RR = 0.68, 95% CI 0.47-0.98), need for diuretics (RR = 0.68, 95% CI 0.48-0.97) and inotropes and/or intra-aortic balloon pump (RR = 0.17, 95% CI 0.04-0.76) were decreased in RIC. On planned 12 months follow-up echocardiography (n = 193 and 173 in RIC and SOC, respectively) ejection fraction (EF) recovery was enhanced in patients presenting with impaired left ventricular (LV) function (10% absolute difference in median EF compared with SOC; P < 0.001). In addition to previously reported improved myocardial salvage index and reduced infarct size RIC was shown beneficial in a combined hard clinical endpoint of cardiac mortality and hospitalization for HF. Improved EF recovery was also documented in patients with impaired LV function.
检验辅助标准治疗（SOC）的远程缺血预处理（RIC）是否可预防 ST 段抬高型心肌梗死（STEMI）后心力衰竭（HF）的进展。
单中心平行 1:1 随机试验（计算机分组，隐藏分组），评估连续 STEMI 患者中 RIC（3 个周期间歇性 5 分钟下肢缺血）与 SOC 的优势（NCT02313961，clinicaltrials.gov）。258 例随机分配至 RIC 或 SOC 的患者中，分别有 9%和 4%因诊断不明确和未识别的排除标准而被排除。与 SOC 相比，RIC 组的心脏死亡率和 HF 住院联合主要结局（n=231 和 217，HR=0.35，95%CI 0.15-0.78）以及各单独结局均降低。两组间血清肌钙蛋白 I 水平无差异。中位和最大随访时间分别为 2.1 年和 3.7 年。住院期间 HF（RR=0.68，95%CI 0.47-0.98）、利尿剂（RR=0.68，95%CI 0.48-0.97）、正性肌力药和/或主动脉内球囊泵（RR=0.17，95%CI 0.04-0.76）的使用率在 RIC 组降低。计划于 12 个月时行超声心动图随访（RIC 和 SOC 组分别为 n=193 和 173），左心室（LV）功能受损患者的射血分数（EF）恢复增强（与 SOC 相比，EF 中位数绝对差值为 10%；P<0.001）。除了之前报道的心肌挽救指数改善和梗死面积减少外，RIC 对心脏死亡率和 HF 住院的联合硬终点也有益。LV 功能受损患者的 EF 恢复也得到改善。
