The RIPOST-MI study, assessing remote ischemic perconditioning alone or in combination with local ischemic postconditioning in ST-segment elevation myocardial infarction

  • Fabrice PrunierEmail author
  • Denis Angoulvant
  • Christophe Saint Etienne
  • Emmanuelle Vermes
  • Martine Gilard
  • Christophe Piot
  • François Roubille
  • Meyer Elbaz
  • Michel Ovize
  • Loïc Bière
  • Julien Jeanneteau
  • Stéphane Delépine
  • Thomas Benard
  • Wissam Abi-Khalil
  • Alain Furber
Original Contribution


Local ischemic postconditioning (IPost) and remote ischemic perconditioning (RIPer) are promising cardioprotective therapies in ST-elevation myocardial infarction (STEMI). We aimed: (1) to investigate whether RIPer initiated at the catheterization laboratory would reduce infarct size, as measured using serum creatine kinase-MB isoenzyme (CK-MB) release as a surrogate marker; (2) to assess if the combination of RIPer and IPost would provide an additional reduction. Patients (n = 151) were randomly allocated to one of the following groups: (1) control group, percutaneous transluminal coronary angioplasty (PTCA) alone; (2) RIPer group, PTCA combined with RIPer, consisting of three cycles of 5-min inflation and 5-min deflation of an upper-arm blood-pressure cuff initiated before reperfusion; (3) RIPer+IPost group, PTCA combined with RIPer and IPost, consisting of four cycles of 1-min inflation and 1-min deflation of the angioplasty balloon. The CK-MB area under the curve (AUC) over 72 h was reduced in RIPer, and RIPer+IPost groups, by 31 and 29 %, respectively, compared to the Control group; however, CK-MB AUC differences between the three groups were not statistically significant (p = 0.06). Peak CK-MB, CK-MB AUC to area at risk (AAR) ratio, and peak CK-MB level to AAR ratio were all significantly reduced in the RIPer and RIPer+IPost groups, compared to the Control group. On the contrary, none of these parameters was significantly different between RIPer+IPost and RIPer groups. To conclude, starting RIPer therapy immediately prior to revascularization was shown to reduce infarct size in STEMI patients, yet combining this therapy with an IPost strategy did not lead to further decrease in infarct size.


Cardioprotection Remote conditioning Reperfusion injury 



This work was supported by academic grants from the Fédération Française de Cardiologie, the Société Française de Cardiologie, and the French Ministry of Health (PHRC 2011), France.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Fabrice Prunier
    • 1
    Email author
  • Denis Angoulvant
    • 2
  • Christophe Saint Etienne
    • 2
  • Emmanuelle Vermes
    • 2
  • Martine Gilard
    • 3
  • Christophe Piot
    • 4
  • François Roubille
    • 4
  • Meyer Elbaz
    • 5
  • Michel Ovize
    • 6
  • Loïc Bière
    • 1
  • Julien Jeanneteau
    • 1
  • Stéphane Delépine
    • 1
  • Thomas Benard
    • 1
  • Wissam Abi-Khalil
    • 1
  • Alain Furber
    • 1
  1. 1.Service de Cardiologie, EA 3860, Laboratoire Cardioprotection, Remodelage et ThromboseUniversité Angers, CHU AngersAngersFrance
  2. 2.Service de Cardiologie, EA 4245, Cellules Dendritiques Immunomodulation et GreffesUniversité François Rabelais de Tours, CHRU de ToursToursFrance
  3. 3.Service de CardiologieUniversité Brest, CHU BrestBrestFrance
  4. 4.Service de CardiologieUniversité 1 Montpellier, CHU MontpellierMontpellierFrance
  5. 5.Service de CardiologieUniversité Toulouse, CHU ToulouseToulouseFrance
  6. 6.Service d’Explorations Fonctionnelles Cardiovasculaires, Inserm U1060-CarMeN, CIC de LyonUniversité Claude Bernard Lyon1, Hôpital Louis PradelLyonFrance

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