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Effect of remote ischaemic preconditioning on clinical outcomes in patients undergoing cardiac bypass surgery: a randomised controlled clinical trial
  1. Luciano Candilio1,
  2. Abdul Malik1,
  3. Cono Ariti2,
  4. Matthew Barnard3,
  5. Carmelo Di Salvo3,
  6. David Lawrence3,
  7. Martin Hayward3,
  8. John Yap3,
  9. Neil Roberts3,
  10. Amir Sheikh3,
  11. Shyam Kolvekar3,
  12. Derek J Hausenloy1,
  13. Derek M Yellon1
  1. 1The Hatter Cardiovascular Institute, University College London, London, UK
  2. 2The Nuffield Trust, London, UK
  3. 3The Heart Hospital, University College London Hospital, London, UK
  1. Correspondence to Dr Derek J Hausenloy, The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London WC1E 6HX, UK; d.hausenloy{at}ucl.ac.uk

Abstract

Objectives Remote ischaemic preconditioning (RIPC), using brief cycles of limb ischaemia/reperfusion, is a non-invasive, low-cost intervention that may reduce perioperative myocardial injury (PMI) in patients undergoing cardiac surgery. We investigated whether RIPC can also improve short-term clinical outcomes.

Methods One hundred and eighty patients undergoing elective coronary artery bypass graft (CABG) surgery and/or valve surgery were randomised to receive either RIPC (2–5 min cycles of simultaneous upper arm and thigh cuff inflation/deflation; N=90) or control (uninflated cuffs placed on the upper arm and thigh; N=90). The study primary end point was PMI, measured by 72 h area under the curve (AUC) serum high-sensitive troponin-T (hsTnT); secondary end point included short-term clinical outcomes.

Results RIPC reduced PMI magnitude by 26% (−9.303 difference (CI −15.618 to −2.987) 72 h hsTnT-AUC; p=0.003) compared with control. There was also evidence that RIPC reduced the incidence of postoperative atrial fibrillation by 54% (11% RIPC vs 24% control; p=0.031) and decreased the incidence of acute kidney injury by 48% (10.0% RIPC vs 21.0% control; p=0.063), and intensive care unit stay by 1 day (2.0 days RIPC (CI 1.0 to 4.0) vs 3.0 days control (CI 2.0 to 4.5); p=0.043). In a post hoc analysis, we found that control patients administered intravenous glyceryl trinitrate (GTN) intraoperatively sustained 39% less PMI compared with those not receiving GTN, and RIPC did not appear to reduce PMI in patients given GTN.

Conclusions RIPC reduced the extent of PMI in patients undergoing CABG and/or valve surgery. RIPC may also have beneficial effects on short-term clinical outcomes, although this will need to be confirmed in future studies.

Trial registration number ClinicalTrials.gov ID: NCT00397163.

  • CARDIAC SURGERY
  • MYOCARDIAL ISCHAEMIA AND INFARCTION (IHD)

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