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

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Authors	D ASCENZO Fabrizio CAVALLERO Erika MORETTI Claudio OMEDE Pierluigi SCIUTO Filippo RAHMAN Ishtiaq A. BONSER Robert S. YUNSEOK Jeon WAGNER Robert FREIBERGER Tomáš KUNST Gudrun MARBER Michael S. THIELMANN Matthias JI Bingyang AMR Yasser M. MODENA Maria Grazia ZOCCAI Giuseppe Biondi SHEIBAN Imad GAITA Fiorenzo
Year of publication	2012
Type	Article in Periodical
Magazine / Source	Heart
MU Faculty or unit	Central European Institute of Technology
Citation
Web	http://heart.bmj.com/content/98/17/1267
Doi	http://dx.doi.org/10.1136/heartjnl-2011-301551
Field	Cardiovascular diseases incl. cardiosurgery
Keywords	RANDOMIZED CONTROLLED-TRIAL; CARDIAC TROPONIN-I; GRAFT-SURGERY; REPERFUSION INJURY; MYOCARDIAL PROTECTION; CARDIOPROTECTION; ISOFLURANE; STRATEGIES; STATEMENT; HUMANS
Attached files	Heart_Ascenzo_2012.pdf
Description	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.
Related projects:	CEITEC - Central European Institute of Technology