Remote ischaemic preconditioning in coronary artery bypass surgery: a meta-analysis

TY - JOUR

T1 - Remote ischaemic preconditioning in coronary artery bypass surgery

T2 - a meta-analysis

AU - D'Ascenzo, Fabrizio

AU - Cavallero, Erika

AU - Moretti, Claudio

AU - Omede, Pierluigi

AU - Sciuto, Filippo

AU - Rahman, Ishtiaq A.

AU - Bonser, Robert S.

AU - Yunseok, Jeon

AU - Wagner, Robert

AU - Freiberger, Tomas

AU - Kunst, Gudrun

AU - Marber, Michael

AU - Thielmann, Matthias

AU - Ji, Bingyang

AU - Amr, Yasser M.

AU - Modena, Maria Grazia

AU - Zoccai, Giuseppe Biondi

AU - Sheiban, Imad

AU - Gaita, Fiorenzo

PY - 2012/9

Y1 - 2012/9

N2 - Aim: Randomised trials exploring remote ischaemic preconditioning (RIPC) in patients undergoing coronary artery bypass graft (CABG) surgery have yielded conflicting data regarding potential cardiovascular and renal protection, and are individually flawed by small sample size. Methods: Three investigators independently searched the MEDLINE, EMBASE and Cochrane databases to identify randomised trials testing RIPC in patients undergoing CABG. Results: Nine studies with 704 patients were included. Standardised mean difference of troponin I and T release showed a significant decrease (-0.36 (95% CI -0.62 to -0.09)). This difference held true after excluding the trials with cross-clamp fibrillation, the study with off-pump CABG and studies using a flurane as anaesthetic agent (-0.41 (95% CI -0.69 to -0.12), -0.38 (95% CI -0.70 to -0.07) and -0.37 (95% CI -0.63 to -0.12), respectively). A similar trend was also obtained for patients with multivessel disease (-0.41 (95% CI -0.73 to -0.08)). The trials evaluating postoperative creatinine reported a non-significant reduction (0.02 (95% CI -0.09 to 0.13)). Moreover, the length of in-hospital stay was not influenced by the kind of treatment (weighted mean difference 0.27 (95% CI -0.24 to 0.79)). Conclusion: RIPC reduced the release of troponin in patients undergoing CABG. Larger randomised trials are needed to clarify the presence of a causal relationship between RIPC-induced troponin release and clinical adverse events.

AB - Aim: Randomised trials exploring remote ischaemic preconditioning (RIPC) in patients undergoing coronary artery bypass graft (CABG) surgery have yielded conflicting data regarding potential cardiovascular and renal protection, and are individually flawed by small sample size. Methods: Three investigators independently searched the MEDLINE, EMBASE and Cochrane databases to identify randomised trials testing RIPC in patients undergoing CABG. Results: Nine studies with 704 patients were included. Standardised mean difference of troponin I and T release showed a significant decrease (-0.36 (95% CI -0.62 to -0.09)). This difference held true after excluding the trials with cross-clamp fibrillation, the study with off-pump CABG and studies using a flurane as anaesthetic agent (-0.41 (95% CI -0.69 to -0.12), -0.38 (95% CI -0.70 to -0.07) and -0.37 (95% CI -0.63 to -0.12), respectively). A similar trend was also obtained for patients with multivessel disease (-0.41 (95% CI -0.73 to -0.08)). The trials evaluating postoperative creatinine reported a non-significant reduction (0.02 (95% CI -0.09 to 0.13)). Moreover, the length of in-hospital stay was not influenced by the kind of treatment (weighted mean difference 0.27 (95% CI -0.24 to 0.79)). Conclusion: RIPC reduced the release of troponin in patients undergoing CABG. Larger randomised trials are needed to clarify the presence of a causal relationship between RIPC-induced troponin release and clinical adverse events.

KW - RANDOMIZED CONTROLLED-TRIAL

KW - CARDIAC TROPONIN-I

KW - GRAFT-SURGERY

KW - REPERFUSION INJURY

KW - MYOCARDIAL PROTECTION

KW - CARDIOPROTECTION

KW - ISOFLURANE

KW - STRATEGIES

KW - STATEMENT

KW - HUMANS

U2 - 10.1136/heartjnl-2011-301551

DO - 10.1136/heartjnl-2011-301551

M3 - Literature review

SN - 1355-6037

VL - 98

SP - 1267

EP - 1271

JO - Heart

JF - Heart

IS - 17

ER -