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Ischaemic preconditioning cardioprotective before CABG
The extent of myocardial injury during coronary artery bypass surgery (CABG) is associated with subsequent patient morbidity and mortality. One potential way to limit this damage is by the use of remote ischaemic preconditioning, whereby several brief episodes of ischaemia in one region or organ protects other tissues or organs, such as the heart, from a subsequent sustained episode of ischaemia. Studies to date have shown that brief ischaemia of non-cardiac tissues such as the kidney, intestine or skeletal muscle may also protect the myocardium. Hausenloy et al aimed at assessing whether transient episodes of ischaemia in one arm could reduce myocardial injury in adults with coronary artery disease undergoing elective CABG.
Fifty-seven adult patients undergoing elective CABG were randomly assigned to receive intervention, defined as three 5-minute cycles of right upper arm ischaemia by inflating a blood pressure cuff up to 200 mm Hg, or control treatment, where a deflated cuff was placed on the right upper arm for 30 minutes. The remote ischaemic preconditioning intervention was applied after the induction of anaesthesia and before surgery started, therefore both the patient and surgeon were unaware of the treatment allocation. Serum troponin-T concentration was then measured before surgery and at 6, 12, 24, 48 and 72 hours after surgery. Compared with patients undergoing control treatment, remote ischaemic preconditioning significantly reduced overall serum troponin-T release at 6, 12, 24 and 48 hours after surgery. The total area under the curve decreased by 43%, from a mean (SD) of 36.12 (26.08) μg/l in the control group to 20.58 (9.58) μg/l in the remote ischaemic preconditioning group (mean difference 15.55 (5.32) μg/l; 95% CI 4.88 to 26.21; p = 0.005).
Therefore in this single-centre study, adults undergoing elective CABG seemed to have less myocardial damage during surgery, as assessed by troponin-T release. Although the actual …