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Journal The Lancet

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Hamidreza Mani, Alexandros-Leonidas Liarakos, Miles J Levy
Published: 7 September 2019
The Lancet, Volume 394; doi:10.1016/s0140-6736(19)31242-5

The publisher has not yet granted permission to display this abstract.
Michael Marmot
Published: 7 September 2019
The Lancet, Volume 394, pp 819-820; doi:10.1016/s0140-6736(19)32035-5

Mohamed Alaa Gouda
Published: 7 September 2019
The Lancet, Volume 394; doi:10.1016/s0140-6736(19)31782-9

The publisher has not yet granted permission to display this abstract.
The Lancet
Published: 7 September 2019
The Lancet, Volume 394; doi:10.1016/s0140-6736(19)32042-2

The publisher has not yet granted permission to display this abstract.
Richard Horton
Published: 7 September 2019
The Lancet, Volume 394; doi:10.1016/s0140-6736(19)32084-7

The publisher has not yet granted permission to display this abstract.
The Lancet
Published: 7 September 2019
The Lancet, Volume 394; doi:10.1016/s0140-6736(19)32041-0

The publisher has not yet granted permission to display this abstract.
Danielle Ofri
Published: 7 September 2019
The Lancet, Volume 394, pp 822-823; doi:10.1016/s0140-6736(19)32036-7

Sheila M Bird
Published: 7 September 2019
The Lancet, Volume 394, pp 827-828; doi:10.1016/s0140-6736(19)31246-2

The publisher has not yet granted permission to display this abstract.
Derek J Hausenloy, Rajesh K Kharbanda, Ulla Kristine Møller, Manish Ramlall, Jens Aarøe, Heerajnarain Bulluck, Tim Clayton, Matthew Dodd, Thomas Engstrom, Richard Evans, et al.
Published: 6 September 2019
The Lancet; doi:10.1016/s0140-6736(19)32039-2

Abstract:SummaryBackgroundRemote 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.
Published: 6 September 2019
The Lancet; doi:10.1016/s0140-6736(19)32092-6

Abstract:Dagenais GR, Leong DP, Rangarajan S, et al. Variations in common diseases, hospital admissions, and deaths in middle-aged adults in 21 countries from five continents (PURE): a prospective cohort study. Lancet 2019; published online Sept 3. http://dx.doi. org/10.1016/S0140-6736(19)32007-0—In this Article, the proportion of deaths in high-income countries due to cardiovascular disease (23%) and to cancer (55%), the legend of figure 3 (which should have specified deaths with a cause ascertained), and the final sentence of the sixth paragraph of the Discussion (which should have stated main causes of death in counties) were incorrect. These corrections have been made to the online version as of Sept 6, 2019, and will be made to the printed Article.
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