Remote Ischemic Conditioning and the Long Road to Clinical Translation

Remote ischemic conditioning (RIC) is the phenomenon whereby brief episodes of peripheral ischemia-reperfusion, typically applied to ≥1 limbs by inflation–deflation of a standard blood pressure cuff, increase the tolerance of the myocardium to a sustained ischemic episode. Compelling preclinical evidence of infarct size reduction with RIC, together with promising results from small, proof-of-concept phase II trials, has yielded cautious optimism that RIC may be the long sought-after cardioprotective strategy capable of attenuating morbidity and mortality in patients having a spontaneous or planned period of prolonged cardiac ischemia. Progress toward clinical translation may, however, be hindered by the recent release of 2 eagerly anticipated phase III trials. ERICCA (Effect of Remote Ischemic Preconditioning on Clinical Outcomes in Patients Undergoing Coronary Artery Bypass Graft Surgery) and RIPHeart (Remote Ischaemic Preconditioning for Heart Surgery), both published in the New England Journal of Medicine and both designed to assess major adverse cardiac and cerebrovascular events after cardiac surgery in RIC-treated cohorts versus sham controls, concluded that RIC had no benefit on clinical outcomes.