Evidence map›Paper›PMID 31500849›Full record

Trial reportLancet (London, England)2019

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

Derek J Hausenloy, Rajesh K Kharbanda, Ulla Kristine Møller, Manish Ramlall, Jens Aarøe, Robert Butler, Heerajnarain Bulluck, Tim Clayton, Ali Dana, Matthew Dodd and 33 more

2 registry-linked trialsOpen access · hybridAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Lancet (London, England), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 174 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
174citing papers in PubMed, 5 pooled it
29.9field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02342522 nacompletednot on this map

Effect of Remote Ischaemic Conditioning on Clinical Outcomes in ST-segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention (CONDI2/ERIC-PPCI)

TypeinterventionalSponsorUniversity College, LondonRan2013 to 2019Enrolled5,413ConditionsSTEMI, Myocardial Reperfusion InjuryArmsRemote ischemic conditioning, Control
NCT04912518 narecruitingnot on this mapstarted 2021, after this paper: background citation

Cardioprotective Effect of Dexmedetomidine in Patients With ST-segment Elevation Myocardial Infarction: a Double-Blind, Multicenter, Randomized, Placebo-Controlled Clinical Trial

TypeinterventionalSponsorHarbin Medical UniversityRan2021 to 2025Enrolled250ConditionsST-segment Elevation Myocardial Infarction (STEMI), Percutaneous Coronary Intervention, CardioprotectionArmsDexmedetomidine (DEX), Placebo (Saline)
3 · Its place in the literature

Who cites it

174 citing papers in PubMed, 5 syntheses or guidelines pooled it, 318 citations in OpenAlex.

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  2. Remote ischemic conditioning for stroke: A critical systematic review.International journal of stroke : official journal of the International Stroke Society · 2024
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114 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

43 authors at 18 institutions in 8 countries.

Derek J HausenloyThe Hatter Cardiovascular Institute, University College London, London, UK; National Institute of Health Research Biomedical Research Centre at University College London Hospitals, Research & Development, London, UK; Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore; National Heart Research Institute Singapore, National Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University Singapore, Singapore; Centro de Biotecnologia-FEMSA, Tecnologico de Monterrey, Monterrey, Mexico. Electronic address: d.hausenloy@ucl.ac.uk.
Rajesh K KharbandaOxford Heart Centre, Oxford University Hospitals National Health Service Trust, Oxford, UK; Department of Cardiovascular Medicine, University of Oxford, Oxford, UK.
Ulla Kristine MøllerDepartment of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Manish RamlallThe Hatter Cardiovascular Institute, University College London, London, UK; University Hospital Southampton National Health Service Foundation Trust, Southampton, UK.
Jens AarøeDepartment of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
Robert ButlerDepartment of Cardiology, University Hospitals of North Midlands, Royal Stoke University Hospital, Stoke-on-Trent, UK.
Heerajnarain BulluckDepartment of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK.
Tim ClaytonClinical Trials Unit and Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK.
Ali DanaPortsmouth Hospitals National Health Service Trust, Portsmouth, UK.
Matthew DoddClinical Trials Unit and Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK.
Thomas EngstromDepartment of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Richard EvansClinical Trials Unit and Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK.
Jens Flensted LassenDepartment of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Erika Frischknecht ChristensenPrehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark.
José Manuel Garcia-RuizInstituto de Investigación Sanitaria del Principado de Asturias, Hospital Universitario de Cabueñes, Oviedo, Spain; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain.
Diana A GorogDepartment of Cardiology, Lister Hospital, East and North Hertfordshire National Health Service Trust, Stevenage, UK; National Heart and Lung Institute, Imperial College London, London, UK.
Jakob HjortDepartment of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Richard F HoughtonServicio de Atención Médica de Urgencia-Asturias, Oviedo, Spain.
Borja IbanezCentro Nacional de Investigaciones Cardiovasculares, Madrid, Spain; Centro de Investigacion Biomedica En Red Cardiovascular, Madrid, Spain; IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain.
Rosemary KnightClinical Trials Unit and Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK.
Freddy K LippertPrehospital Emergency Medical Services, Capital Region of Denmark, Denmark.
Jacob T LønborgDepartment of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Michael MaengThe Hatter Cardiovascular Institute, University College London, London, UK.
Dejan MilasinovicDepartment of Cardiology, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Ranjit MoreLancashire Cardiac Centre, Blackpool Teaching Hospitals National Health Service Foundation Trust, Blackpool, UK.
Jennifer M NicholasClinical Trials Unit and Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK.
Lisette Okkels JensenDepartment of Cardiology, Odense University Hospital, Odense, Denmark.
Alexander PerkinsClinical Trials Unit and Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK.
Nebojsa RadovanovicCardiology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Emergency Centre, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Roby D RakhitRoyal Free Hospital London and Institute of Cardiovascular Science, University College London, London, UK.
Jan RavkildeDepartment of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
Alisdair D RydingDepartment of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK.
Michael R SchmidtThe Hatter Cardiovascular Institute, University College London, London, UK.
Ingunn Skogstad RiddervoldPrehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark.
Henrik Toft SørensenDepartment of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Goran StankovicCardiology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Department for Diagnostic and Catheterization Laboratories, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Madhusudhan VarmaThe Heart Centre, North Cumbria University Hospitals National Health Service Trust, Carlisle, UK.
Ian WebbKing's College Hospital, King's Health Partnership, London, UK.
Christian Juhl TerkelsenThe Hatter Cardiovascular Institute, University College London, London, UK.
John P GreenwoodLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK; Leeds Teaching Hospitals National Health Service Trust, Leeds, UK.
Derek M YellonThe Hatter Cardiovascular Institute, University College London, London, UK.
Hans Erik BøtkerThe Hatter Cardiovascular Institute, University College London, London, UK. Electronic address: haboet@rm.dk.
CONDI-2/ERIC-PPCI Investigators
National Health Service · GBUniversity College London · GBLondon School of Hygiene & Tropical Medicine · GBSpanish National Centre for Cardiovascular Research · ESNorfolk and Norwich University Hospital · GBUniversity of Belgrade · RSAarhus University Hospital · DKGobierno del Principado de Asturias · ESRoyal Stoke University Hospital · GBUniversity of Copenhagen · DKAalborg University Hospital · DKCentral Denmark Region · DKThe Royal Free Hospital · GBKings Health Partners · GBOdense University Hospital · DKAarhus University · DKCapital Region of Denmark · DKNational University of Singapore · SG

Funding

British Heart Foundation CS/14/3/31002British Heart Foundation FS/10/039/28270Medical Research Council MC_G1002673
6 · The paper itself

Abstract

backgroundRemote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months.

methodsWe did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed.

findingsBetween Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed.

interpretationRemote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI.

fundingBritish Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden.

Indexed as

Percutaneous Coronary InterventionAgedCombined Modality TherapyDeath, Sudden, CardiacFemaleHeart FailureHospitalizationHumansIntention to Treat AnalysisIschemic Preconditioning, MyocardialMaleMiddle AgedMyocardial InfarctionProspective StudiesSingle-Blind MethodTreatment Outcome

Identifiers

PMID31500849
PMCPMC6891239
OpenAlexW2972010323

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.