Remote Ischemic Conditioning With Local Ischemic Postconditioning in High-Risk ST-elevation Myocardial Infarction

Coronary reperfusion by percutaneous coronary intervention is mandatory to salvage ischemic myocardium and to reduce definite infarct size. However, reperfusion itself also causes irreversible myocardial damage - a phenomenon described as reperfusion injury. Reduction of ischemic and reperfusion injury by ischemic conditioning has been identified as a potential target to reduce myocardial damage.

Remote ischemic conditioning and local ischemic postconditioning might be in particular of clinical benefit in higher risk STEMI patients with Killip class ≥2, where mortality rates are high.

The Remote Ischemic Conditioning with Local Ischemic Postconditioning in High-Risk ST-elevation myocardial infarction patients (RIP-HIGH) trial is a two-arm randomized controlled trial aiming to compare the impact of combined remote ischemic conditioning and local ischemic postconditioning vs. standard of care on clinical outcome in high-risk ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.

Inclusion criteria

• Acute chest pain lasting <12 h
• ST-elevation at the J-point in two contiguous leads of ≥2 mm in men ≥40 years, ≥2.5 mm in men <40 years and ≥1.5 mm in women (regardless of age) in V2-V3 and/or ≥1 mm in all other leads (52).
• New or presumed new left bundle branch block or right bundle branch block.
• Killip class ≥II on hospital admission or requirement of diuretics because of clinical congestion.
• Written informed consent.

Exclusion criteria

• Killip class I on hospital admission.
• Prior fibrinolysis.
• Conditions precluding use of RIC (i.e. paresis of the upper limb, presence of an arteriovenous shunt).
• Pregnancy.
• Age <18 years.
• Severe co-morbidity with a life expectancy <6 months.
• Participation in another trial.