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Remote ischemic conditioning fails to benefit patients with STEMI undergoing PCI

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PARIS — Among patients undergoing PCI for STEMI, remote ischemic conditioning did not reduce cardiac death and HF hospitalization at 12 months, researchers reported at the European Society of Cardiology Congress.

The researchers merged the randomized CONDI-2 and ERIC-PPCI trials to evaluate remote ischemic conditioning with a cuff (AutoRIC, CellAegis) in 5,401 patients with STEMI who had PCI (mean age, 63 years; 23% women). In ERIC-PPCI, the control group was assigned a sham procedure; in CONDI-2, the control group received no conditioning or sham procedure.

The primary endpoint of cumulative incidence of cardiac death or HF hospitalization at 12 months occurred in 9.4% of the intervention group and 8.6% of the control group (HR = 1.1; 95% CI, 0.91-1.32), Hans Erik Bøtker, MD, PhD, FESC, FACC, professor of cardiology at Aarhus University Hospital in Denmark, said during a presentation.

“I would not be quite honest if I didn’t admit that we were somewhat disappointed about these results, given the majority of the results we have seen in previous proof-of-concept trials,” he said.

He said there were also no differences between the groups in any secondary outcomes, including cardiac death or HF hospitalization at 30 days and the following 12-month endpoints: major cardiac and cerebrovascular events, all-cause mortality, reinfarction, unplanned revascularization, stroke, new implantable cardioverter defibrillator or repeat HF hospitalization episodes. Nor, he said, did the groups differ in troponin T release, indicating no difference in infarct size.

The results did not vary by age, diabetes status, TIMI flow grade at admission, infarct location or time between first medical contact and balloon angioplasty, according to the researchers.

“One might question whether ischemia reperfusion injury is really a target for cardioprotection, in particular because we saw no difference in biomarker release; however, this is not a unique finding,” Bøtker said during the presentation. “Biomarkers may not be sufficiently accurate to evaluate the reduction in infarct size in humans. Our findings do not refute whether ischemia reperfusion injury can be a target for modification, but they question whether its magnitude is sufficient to translate into a clinical benefit.” – by Erik Swain

Reference:

Bøtker HE, et al. Hot Line Session 2. Presented at: European Society of Cardiology Congress; Aug. 31-Sept. 4, 2019; Paris.

Disclosure: Bøtker reports he is a shareholder of CellAegis.