Remote Ischemic Perconditioning in Patients With ST-segment Elevation Myocardial Infarction

NCT ID: NCT02164695

Last Updated: 2021-11-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

118 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-01-31

Study Completion Date

2018-01-31

Brief Summary

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To evaluate whether remote ischemic per-conditioning (RIPC) can reduce infarct size in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention (PPCI) within 12 hours of symptoms onset.

* Control group: PPCI only
* Study group: PPCI + RIPC

Primary endpoint: Infarct size measured by contrast-enhanced cardiac magnetic resonance (CMR) at 6 months after the index procedure

Detailed Description

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ST-elevation myocardial infarction (STEMI) is a leading cause of mortality and morbidity. Early myocardial reperfusion with either of thrombolytic therapy or primary percutaneous coronary intervention (PPCI) is the most effective strategy for reducing the size of a myocardial infarct and improving the clinical outcome. Although this process can restore blood flow to the ischemic myocardium, it can induce injury. This phenomenon termed myocardial reperfusion injury can paradoxically reduce the beneficial effects of myocardial reperfusion. The pre-clinical study in animal models of acute myocardial infarction suggests that lethal reperfusion injury accounts for up to 50% of the final size of a myocardial infarct.

Remote ischemic conditioning uses brief ischemia and reperfusion of a distant organ to protect the myocardium. In animal study, remote ischemic postconditioning seems to be more effective than local postconditioning in experimental myocardial infarction.Bøtker et al. has reported remote ischemic preconditioning before hospital admission increase myocardial salvage in patients with acute myocardial infarction.

The objective of this study is to evaluate whether remote ischemic per-conditioning (RIPC) can reduce late infarct size in patients with STEMI treated with PPCI within 12 hours of symptoms onset. To test this hypothesis, we will randomize patients into PPCI + RIPC or PPCI alone. We will evaluate marker of reperfusion injury using contrast cardiac magnetic resonance image.

Conditions

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ST-segment Elevation Myocardial Infarction

Keywords

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ST-segment elevation myocardial infarction Remote ischemic perconditioning Primary percutaneous coronary intervention Cardiac magnetic resonance

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

* Control group: PPCI only
* Study group: PPCI + RIPC
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
CMR results will be interpreted by observers blinded to randomization

Study Groups

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PPCI plus RIPC

The patients randomized to PPCI plus RIPC group will receive RIPC during PPCI.

Group Type ACTIVE_COMPARATOR

PPCI plus RIPC

Intervention Type PROCEDURE

All patients will be prepared with an upper-arm blood pressure cuff before arterial puncture (contralateral in case of radial access). In patients allocated into PPCI plus RIPC group, the protocol will be started immediately after cuff preparation. Upper-arm will be exposed to 4 cycles of ischemia/reperfusion, each obtained by 5 min cuff inflation at 200mmHg, followed by 5 min complete deflation.

PPCI only

The patients randomized to PPCI only group will receive PPCI only but the sham procedure of RIPC.

Group Type SHAM_COMPARATOR

PPCI only

Intervention Type PROCEDURE

All patients randomized to PPCI only arm, the blood pressure cuff will be applied to the arm or the calf but will not be inflated.

Interventions

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PPCI plus RIPC

All patients will be prepared with an upper-arm blood pressure cuff before arterial puncture (contralateral in case of radial access). In patients allocated into PPCI plus RIPC group, the protocol will be started immediately after cuff preparation. Upper-arm will be exposed to 4 cycles of ischemia/reperfusion, each obtained by 5 min cuff inflation at 200mmHg, followed by 5 min complete deflation.

Intervention Type PROCEDURE

PPCI only

All patients randomized to PPCI only arm, the blood pressure cuff will be applied to the arm or the calf but will not be inflated.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Age \>19 years
* Presenting within 12 hours of symptom onset
* \>20 min of chest pain
* ST-elevation myocardial infarction defined as ST-segment elevation (\>0.1 mV) in at least 2 contiguous precordial leads

Exclusion Criteria

* Previous myocardial infarction
* Presence of chronic total occlusion
* Evidence of retrograde filling by collaterals at coronary angiography (Rentrop 2 or 3 collateral flow)
* Severe multi-vessel coronary artery disease to require further interventions before follow-up CMR
* Cardiac arrest before randomization
* Arrhythmias requiring external electric shock before randomization
* Unwillingness to participate
* External electric shock for cardioversion within first 3 days
* Cardiac surgery within first 3 days
Minimum Eligible Age

19 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Yonsei University

OTHER

Sponsor Role lead

Responsible Party

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Young Jin Youn, MD, PhD

Professor, Division of Cardiology, Department of Internal Medicine, Yonsei Univeristy Wonju College of Medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Young Jin Youn, MD

Role: PRINCIPAL_INVESTIGATOR

Yonsei Univeristy Wonju College of Medicine

Locations

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Wonju Severance Christian Hospital

Wŏnju, Gangwon-do, South Korea

Site Status

Countries

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South Korea

Other Identifiers

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CR314003

Identifier Type: -

Identifier Source: org_study_id