The efficacy of remote ischemic conditioning for outcomes in ischemic stroke patients with or without prior stroke: A post hoc analysis of the RICAMIS trial.

Background And Purpose: To investigate the impact of a history of ischemic stroke or transient ischemic attack (TIA) on the effectiveness of remote ischemic conditioning (RIC) for outcomes in acute ischemic stroke patients.

Methods: We conducted a post hoc analysis of the Remote Ischaemic Conditioning for Acute Moderate Ischaemic Stroke (RICAMIS) trial. Patients in RICAMIS were categorized into two groups according to a history of stroke. The primary outcome was an excellent functional outcome, defined as a modified Rankin Scale (mRS) score of 0-1 at 90 days. Instead of comparing patients receiving usual care alone, we investigated the association of the RIC effect with functional outcomes in each group and the interaction between the RIC effect and a history of ischemic stroke or TIA.

Results: We included a total of 1695 patients, of whom 562 patients had a history of ischemic stroke or TIA and 1133 patients without prior ischemic stroke or TIA. In the Never Stroke or TIA group, a higher proportion of excellent functional outcomes was found in the RIC subgroup compared to the control subgroup (adjusted OR = 1.557 [95% CI 1.187-2.043], p = 0.001) but not in Prior Stroke or TIA group (adjusted OR = 1.299 [95% CI 0.893-1.888], p = 0.171). However, no significant interaction between the RIC effect and a history of ischemic stroke or TIA was found among the groups.

Conclusion: This is the first report suggesting that the RIC effect may be influenced by the history of ischemic stroke or TIA for patients with acute ischemic stroke.