Field implementation of remote ischemic conditioning in STEMI (FIRST)

PI: Sheldon Cheskes


Status: Completed, in review at Circulation



Background: Remote ischemic conditioning (RIC) is a non-invasive, therapeutic strategy that uses brief cycles of blood pressure cuff inflation and deflation to protect the myocardium against ischemia-reperfusion injury. Previous research employing a strategy of RIC prior to percutaneous coronary intervention (PCI) has demonstrated improvements in minimizing infarct size, yet little is known regarding the impact of RIC on clinical outcomes.

Objective: To determine the impact of RIC prior to PCI for ST-segment elevation myocardial infarction (STEMI) on clinical outcomes compared to standard care.

Methods: We conducted a pre and post implementation study in two community hospitals and two ambulance services in Ontario, Canada. Pre-implementation (December 2013- July 2016), patients with presumed STEMI were taken directly to the PCI lab for coronary intervention. Post-implementation (July 2016-August 2018), patients with presumed STEMI received four cycles of RIC applied to the upper extremity using an automated device by paramedics or emergency department staff prior to PCI. The primary outcome was major adverse cardiovascular events (MACE) at 90 days. Secondary outcomes included hospital length of stay, MACE at 30, 60, and 180-days. Inverse probability of treatment weighting using propensity score estimated causal effects independent of baseline covariables.