Remote Ischemic Conditioning as an Adjunct to Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial...

Remote ischaemic conditioning (RIC) is a non-invasive technique that applies brief, repeated cycles of limb ischaemia and reperfusion using a blood pressure cuff and has been investigated as an adjunct cardioprotective strategy during primary percutaneous coronary intervention (PPCI) in patients with ST-elevation myocardial infarction (STEMI). Despite encouraging experimental data, findings from randomized controlled trials (RCTs) have been inconsistent, and their overall impact on both functional and clinical outcomes remains uncertain. We performed a systematic review and meta-analysis of RCTs comparing RIC plus PPCI with PPCI alone in patients with STEMI. A comprehensive search of PubMed, Cochrane Library, Scopus, and Web of Science was conducted up to March 2026. The primary endpoints were left ventricular ejection fraction (LVEF) and infarct size, while secondary endpoints included all-cause mortality, cardiovascular mortality, major adverse cardiovascular events (MACE), heart failure hospitalization, recurrent myocardial infarction (MI), and repeat revascularization. Data were pooled using a random-effects DerSimonian-Laird model, and outcomes were reported as mean difference (MD), risk ratio (RR), log risk ratio, and 95% confidence interval (CI). A total of 21 RCTs encompassing 8,392 patients were included. Remote ischaemic conditioning showed a modest but statistically significant increase in LVEF (MD 1.23%, 95% CI 0.05-2.42; p = 0.04; I² = 0%) and a reduction in recurrent MI (log RR -0.24; 95% CI -0.48 to -0.01; p = 0.04; I² = 0%). No significant effect was observed on infarct size (MD -0.62; p = 0.22). Similarly, no differences were identified in all-cause mortality, cardiovascular mortality, MACE, heart failure hospitalization, or repeat revascularization. Sensitivity analyses confirmed the robustness of most outcomes, although exclusion of the CONDI-2/ERIC-PPCI trial influenced the significance of cardiovascular mortality and MACE. Overall, in STEMI patients undergoing PPCI, adjunctive RIC may provide modest improvement in left ventricular function and reduction in recurrent MI, but it does not clearly reduce major clinical events. Current evidence does not support routine clinical use, and further well-designed stratified trials are required to identify patient groups who may benefit most and to optimize treatment protocols.