Gaspar A, et al. - 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), was investigated herein. Previously, it has been reported that RIC provided improved myocardial salvage index and reduced infarct size. In addition to this, RIC was shown beneficial in a combined hard clinical endpoint of cardiac mortality and hospitalization for HF in this current investigation. In patients with impaired left ventricular function, improved ejection fraction recovery was also documented.

• This single-centre parallel 1:1 randomized trial (computerized block-randomization, concealed allocation) was conducted to evaluate superiority of RIC (3 cycles of intermittent 5 min lower limb ischaemia) over SOC in consecutive STEMI patients.
• A total of 258 patients were randomized to RIC or SOC, of those, 9 and 4% were excluded because of unconfirmed diagnosis and previously unrecognized exclusion criteria, respectively.

• Findings demonstrated that in RIC vs SOC, combined primary outcome of cardiac mortality and hospitalization for HF was reduced (n = 231 and 217, respectively; HR = 0.35, 95% CI 0.15–0.78) as well as each outcome in isolation.
• Serum troponin I levels did not differ between groups.
• Data showed that median and maximum follow-up time were 2.1 and 3.7 years, respectively.
• In RIC, the following were noted to be decreased: 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).
• Enhanced ejection fraction (EF) recovery in patients presenting with impaired left ventricular (LV) function (10% absolute difference in median EF compared with SOC; P < 0.001) was noted on planned 12 months follow-up echocardiography (n = 193 and 173 in RIC and SOC, respectively).