Inclusion Criteria:  Acute chest pain lasting <12 h ST-elevation at the J-point in two contiguous leads of ≥2 mm in men ≥40 years, ≥2.5 mm in men <40 years and ≥1.5 mm in women (regardless of age) in V2-V3 and/or ≥1 mm in all other leads (52). New or presumed new left bundle branch block or right bundle branch block. Killip class ≥II on hospital admission or requirement of diuretics because of clinical congestion. Written informed consent.  Exclusion Criteria:  Killip class I on hospital admission. Prior fibrinolysis. Conditions precluding use of RIC (i.e. paresis of the upper limb, presence of an arteriovenous shunt). Pregnancy. Age <18 years. Severe co-morbidity with a life expectancy <6 months. Participation in another trial.