Purpose Despite evidence of myocardial infarct size reduction in animal studies, remote ischaemic conditioning (RIC) failed to improve clinical outcomes in the large CONDI-2/ERIC-PPCI trial. Potential reasons include that the predominantly low-risk study participants all received timely optimal reperfusion therapy by primary percutaneous coronary intervention (PPCI). Whether RIC can improve clinical outcomes in higher-risk STEMI patients in environments with poor access to early reperfusion or PPCI will be investigated in the RIC-AFRICA trial. Methods The RIC-AFRICA study is a sub-Saharan African multi-centre, randomized, double-blind, sham-controlled clinical trial designed to test the impact of RIC on the composite endpoint of 30-day mortality and heart failure in 1200 adult STEMI patients without access to PPCI. Randomized participants will be stratified by whether or not they receive thrombolytic therapy within 12 h or arrive outside the thrombolytic window (12–24 h). Participants will receive either RIC (four 5-min cycles of inflation [20 mmHg above systolic blood pressure] and deflation of an automated blood pressure cuff placed on the upper arm) or sham control (similar protocol but with low-pressure inflation of 20 mmHg and deflation) within 1 h of thrombolysis and applied daily for the next 2 days. STEMI patients arriving greater than 24 h after chest pain but within 72 h will be recruited to participate in a concurrently running independent observational arm. Conclusion The RIC-AFRICA trial will determine whether RIC can reduce rates of death and heart failure in higher-risk sub-optimally reperfused STEMI patients, thereby providing a low-cost, non-invasive therapy for improving health outcomes.

Background Despite investments to improve the quality of emergency care for patients with acute myocardial infarction (AMI), few studies have described national, real-world trends in non-ST elevation myocardial infarction (NSTEMI) care in the emergency department (ED). We aimed to describe the characteristics, management, and outcomes of NSTEMI. Methods A prospective single-center study enrolled 40 NSTEMI patients in Alshaab Teaching Hospital during the period from May to July 2021. Data regarding demographics, medical history, clinical presentations, laboratory investigation, Killip classifications, electrocardiography (ECG), echocardiogram, diagnostic coronary angiography (CAG), management strategies, medications used, and 30-days outcomes were collected. Results Among 40 patients, NSTEMI was common in the age groups from 56 to 70 years (60%) and males (67.5%; p=0.002). Diabetes (n=24; 60%) and hypertension (n=20; 50%) were the major cardiovascular disease (CVD) risk factors. In most of the cases, 29 (72%) had a late presentation (>6 hours; p=0.0001). In Killip classifications, 36 (90%) patients were Killip class I and four (10%) were Killip class II (p=0.005). No patients underwent risk score assessment during a hospital stay. All patients had sinus rhythm in ECG and 28 (70%) had T-wave inversion. An echocardiogram was performed for 36 (90%) patients, among them six (16.7%) patients had LV systolic dysfunction (p=.003). The median ejection fraction was 52% (ranged from 25-75%). Diagnostic CAG was performed for 38 (95%) patients and a stent was inserted for 23 (58%) of them. The major final management strategy among our study group was PCI in 23 (58%) patients. All patients received aspirin, clopidogrel, parenteral anticoagulant, and ACEi/ARBs, 38 (95%) had statin, 28 (70%) were given PPI, and seven (17.5%) received diuretics. As for 30-day outcomes, all patients survived, but ten (25%) patients were readmitted, and no in-hospital or 30-days mortality occurred. Conclusion NSTEMI predominantly affected male and older patients. Most of them had a delayed presentation to ED. Hypertension and DM were the major risk factors. All patients were in sinus rhythm and the main ECG abnormality was a T-wave inversion. Most of the patients received standard NSTEMI protocol with exception of risk stratification. PCI was the major final management strategy used. Albeit no in-hospital or 30-days mortality occurred, 25% were readmitted.