COmprehensive Remote Ischemic Conditioning in Myocardial Infarction

Inclusion Criteria:

• Suspected anterior STEMI: new ST-elevation > 0.1 millivolt (mV) (≥ 0.2 mV in men or ≥ 0.15 mV in women in leads V2-V3) in > two contiguous leads in V1-V6; new or presumednew left bundle branch block;

• Symptom onset no more than 12 h before presentation and planned primary PCI;

• Age 18 to 75 years;

• Willingness and capability to provide informed consent.

Exclusion Criteria:

• Previous anterior myocardial infarction;

• Previous coronary artery bypass graft (CABG);

• Myocardial infarction or stroke within the previous 30 days;

• Treatment with thrombolysis within the previous 30 days;

• Cardiogenic shock;

• Thrombolysis in myocardial infarction (TIMI) flow grade 2 or 3 at coronaryangiography;

• Coronary anatomy or mechanical complication of STEMI (ventricular septal rupture, freewall rupture, acute severe mitral regurgitation) warranting emergent surgery;

• Inability to obtain TIMI flow grade ≥ 2;

• Conditions precluding use of RIC (paresis of lower limb, known severe peripheralartery disease or evidence of lower limb ischemia, and etc.);

• Life expectancy of less than 12 months due to non-cardiac disease such as knownmalignancy or other comorbid conditions;

• Contraindications to CMR;

• Treated with therapeutic hypothermia before admission;

• Pregnancy and lactating women;

• Participation in another interventional trial.