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.

The experience of using maraviroc by our study participants shows similarity in terms of efficacy and safety to the MERIT and MOTIVATE clinical trials.

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BackgroundAcute exacerbations of COPD (AECOPD) are the second most common cause of emergency hospital admission in England and are associated with an inpatient mortality rate of 4.3%.1 The Dyspnoea, Eosinopenia, Consolidation, Acidaemia and Atrial Fibrillation (DECAF) Score, is an effective prognostic tool that predict mortality in AECOPD admissions. This scoring system is easy to apply during admission and has performed better than existing prognostic tools.2 We aim to appraise the efficacy of DECAF score in our busy respiratory and medical admissions unit.MethodHospital admissions with AECOPD from Dec 2014 to Mar 2015 are prospectively reviewed and DECAF score applied to each patient. Morbidity and mortality indicators were then correlated with both total DECAF scores and each predictive index.Results78 admissions were reviewed, 60% were male and the mean age was 72.7 years. Average length of stay was 15.3 days and 12 patients died in hospital. Our results were comparable with previous studies3, with inpatient mortality highest in those with DECAF scores of 3–5 (92%) and lowest in those with scores of 0–1 (0%). Higher DECAF scores were also associated with use of non-invasive ventilation (43%).Furthermore, each individual predictive index within the DECAF score was independently related to an increased mortality rate. There was 44% mortality in patients with atrial fibrillation and 30% mortality in patients with dyspnoea score of eMRC 5B. In-hospital mortality rate increased with each DECAF score (Figure 1).Abstract P45 Figure 1 ConclusionsIntroduction of DECAF score as clinical prediction tool for AECOPD admissions in our departments may be beneficial in reducing morbidity and mortality. Those scoring highest should be considered for early escalation, higher level of care and or palliative management. Those with lower scores may be suitable for early supported discharge. Further study of a larger group however is advisable to confirm the significance of these findings.References1 National Chronic Obstructive Pulmonary Disease Audit Programme: Clinical audit of COPD exacerbations admitted to acute units in England and Wales, 20142 J Steer, J Gibson, S Bourke. The DECAF Score: predicting hospital mortality in exacerbations of chronic obstructive pulmonary disease. Thorax 2012;67:970–976

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