title: Cardioprotection by combined intrahospital remote ischaemic perconditioning and postconditioning in ST-elevation myocardial infarction: the randomized LIPSIA CONDITIONING trial.
abstract: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  Combined intrahospital RIC + PostC in conjunction with PCI in STEMI significantly improves myocardial salvage in comparison with control and PostC.
  
  
  BACKGROUND
  NCT02158468.
authors.affiliation: University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany ingoeitel@gmx.de.
authors.forename: Ingo
authors.initials: I
authors.lastname: Eitel
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig - Heart Center, Leipzig, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Stiermaier
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig - Heart Center, Leipzig, Germany.
authors.forename: Karl P
authors.initials: KP
authors.lastname: Rommel
authors.affiliation: University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Fuernau
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig - Heart Center, Leipzig, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Sandri
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig - Heart Center, Leipzig, Germany.
authors.forename: Norman
authors.initials: N
authors.lastname: Mangner
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig - Heart Center, Leipzig, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Linke
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig - Heart Center, Leipzig, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Erbs
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig - Heart Center, Leipzig, Germany.
authors.forename: Phillip
authors.initials: P
authors.lastname: Lurz
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig - Heart Center, Leipzig, Germany.
authors.forename: Enno
authors.initials: E
authors.lastname: Boudriot
authors.affiliation: Clinical Trial Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Meinhard
authors.initials: M
authors.lastname: Mende
authors.affiliation: University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Desch
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig - Heart Center, Leipzig, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.affiliation: University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006760:Hospitalization; D006801:Humans; D057775:Ischemic Postconditioning / Q000379:methods*; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D011446:Prospective Studies; D019114:Remote Consultation; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers
keywords: Cardioprotection; Myocardial salvage; Postconditioning; Remote ischaemic conditioning