Remote ischaemic preconditioning in coronary artery bypass surgery: a meta-analysis
- Fabrizio D'Ascenzo1,2,
- Erika Cavallero1,
- Claudio Moretti1,2,
- Pierluigi Omedè1,
- Filippo Sciuto1,
- Ishtiaq A Rahman3,
- Robert S Bonser3,
- Jeon Yunseok4,
- Robert Wagner5,
- Tomas Freiberger5,6,
- Gudrun Kunst7,
- Michael S Marber7,
- Matthias Thielmann8,
- Bingyang Ji9,
- Yasser M Amr10,
- Maria Grazia Modena11,
- Giuseppe Biondi Zoccai2,11,
- Imad Sheiban1,
- Fiorenzo Gaita1
- 1Division of Cardiology, University of Turin, Turin, Italy
- 2Meta-analysis and Evidence based medicine Training in Cardiology (METCARDIO), Ospedaletti, Italy
- 3Department of Cardiothoracic Surgery University Hospital Birmingham NHS Trust, Birmingham, UK
- 4Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
- 5Centre for Cardiovascular Surgery and Transplantation Brno, Czech Republic
- 6Ceitec, Masaryk University, Brno, Czech Republic
- 7Department of Anaesthetics, Intensive Care Medicine and Pain Therapy, King's College Hospital NHS Foundation Trust, London, UK
- 8Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen, Germany
- 9Department of Cardiopulmonary Bypass, Cardiovascular Institute & Fuwai Hospital, PUMC & CAMS, Beijing, China
- 10Tanta faculty of Medicine, Egypt
- 11Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy
- Correspondence to Dr Claudio Moretti, Division of Cardiology, University of Turin, Turin, Italy;
Contributors FDA, EC, CM, and GBZ conceived the paper, and wrote it along with PO, FS, MGM, IS and FG. IAR, RSB, YMA, RW, TF, GK, MSM, MT, BJ and YMA gave data from their studies and participated in the drawing up of the discussion.
- Received 28 December 2011
- Revised 27 February 2012
- Accepted 1 April 2012
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.
- great vessels and trauma
- cardiac function
- coronary stenting
- population studies
- remodelling of LV
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; internally peer reviewed.