Remote Ischaemic Conditioning in STEMI Patients in Sub-Saharan AFRICA: Rationale and Study Design for the RIC-AFRICA Trial
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Date
2021-11-05
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Cardiovascular Drugs and Therapy
Abstract
Despite evidence of myocardial infarct size reduction in animal studies, remote ischaemic conditioning (RIC)
failed to improve clinical outcomes in the large CONDI-2/ERIC-PPCI trial. Potential reasons include that the predominantly
low-risk study participants all received timely optimal reperfusion therapy by primary percutaneous coronary intervention
(PPCI). Whether RIC can improve clinical outcomes in higher-risk STEMI patients in environments with poor access to
early reperfusion or PPCI will be investigated in the RIC-AFRICA trial. The RIC-AFRICA study is a sub-Saharan African multi-centre, randomized, double-blind, sham-controlled clinical
trial designed to test the impact of RIC on the composite endpoint of 30-day mortality and heart failure in 1200 adult STEMI
patients without access to PPCI. Randomized participants will be stratified by whether or not they receive thrombolytic
therapy within 12 h or arrive outside the thrombolytic window (12–24 h). Participants will receive either RIC (four 5-min
cycles of inflation [20 mmHg above systolic blood pressure] and deflation of an automated blood pressure cuff placed on
the upper arm) or sham control (similar protocol but with low-pressure inflation of 20 mmHg and deflation) within 1 h of
thrombolysis and applied daily for the next 2 days. STEMI patients arriving greater than 24 h after chest pain but within 72
h will be recruited to participate in a concurrently running independent observational arm. The RIC-AFRICA trial will determine whether RIC can reduce rates of death and heart failure in higher-risk
sub-optimally reperfused STEMI patients, thereby providing a low-cost, non-invasive therapy for improving health outcomes.
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Citation
Lukhna, K., Hausenloy, D. J., Ali, A. S., Bajaber, A., Calver, A., Mutyaba, A., ... & Yellon, D. M. (2023). Remote ischaemic conditioning in STEMI patients in sub-Saharan AFRICA: rationale and study design for the RIC-AFRICA trial. Cardiovascular Drugs and Therapy, 37(2), 299-305.