title: Impact of cardiovascular risk factors and medication use on the efficacy of remote ischaemic conditioning: post hoc subgroup analysis of a randomised controlled trial.
abstract: OBJECTIVE
  Remote ischaemic conditioning (RIC) promotes cardioprotection in patients undergoing primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI). The effect of RIC may be modified by cardiovascular risk factors and their medications. We examined whether cardiovascular risk factors, lipid and glucose levels, and medication use influenced the efficacy of RIC in patients with STEMI treated with pPCI.
  
  
  METHODS
  Post hoc subgroup analysis of a single-centre randomised controlled trial.
  
  
  METHODS
  A total of 139 patients with STEMI, randomised during ambulance transport to hospital for pPCI with (n=71) or without (n=68) RIC, met the trial criteria and achieved data for a myocardial salvage index (MSI).
  
  
  METHODS
  RIC was administered through intermittent arm ischaemia with four cycles of 5 min inflation and 5 min deflation of a blood pressure cuff.
  
  
  METHODS
  MSI, estimated by single-photon emission CT. We evaluated the efficacy of RIC on the MSI in patient subgroups of cardiovascular risk factors, lipid and glucose levels, and medication use.
  
  
  RESULTS
  We found no significant difference in the efficacy of RIC in subgroups of cardiovascular risk factors, lipid and glucose levels, and medication use. However, point estimates indicated a reduced effect of RIC among smokers (median difference in MSI between RIC and control groups: -0.02 (95% CI -0.32 to 0.28) in smokers vs 0.25 (95% CI 0.08 to 0.42) in non-smokers, p value for interaction=0.13) and an increased effect of RIC in statin users (median difference in MSI between RIC and control groups: 0.34 (95% CI 0.03 to 0.65) in statin users vs 0.09 (95% CI -0.11 to 0.29) in non-statin users, p value for interaction=0.19).
  
  
  CONCLUSIONS
  RIC as an adjunct to pPCI seems to improve MSI in our trial population of patients with STEMI regardless of most cardiovascular risk factors and their medications. Our post hoc finding on a limited sample size calls for further investigation in large-scale multicentre trials.
  
  
  BACKGROUND
  NCT00435266.
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: Astrid Drivsholm
authors.initials: AD
authors.lastname: Sloth
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: Michael Rahbek
authors.initials: MR
authors.lastname: Schmidt
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: Kim
authors.initials: K
authors.lastname: Munk
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Schmidt
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Pedersen
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: Henrik Toft
authors.initials: HT
authors.lastname: Sørensen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: Hans Erik
authors.initials: HE
authors.lastname: Bøtker
mesh_terms: D000368:Aged; D001132:Arm / Q000098:blood supply; D001786:Blood Glucose / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000209:etiology / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D007511:Ischemia; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods*; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D009206:Myocardium / Q000473:pathology; D062645:Percutaneous Coronary Intervention; D012039:Regional Blood Flow; D012307:Risk Factors; D012907:Smoking; D019722:Sphygmomanometers; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids
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