Does remote ischaemic preconditioning with postconditioning improve clinical outcomes of patients undergoing cardiac surgery? Remote Ischaemic Preconditioning with Postconditioning Outcome Trial

Hong, Deok Man; Lee, Eun‐Ho; Kim, Hyun Joo; Min, Jeong Jin; Chin, Ji Hyun; Choi, Dae Ki; Bahk, Jae Hyon; Sim, Ji Yeon; Choi, In‐Cheol; Jeon, Yunseok

doi:10.1093/eurheartj/eht346

Cited by 105 publications

(107 citation statements)

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“…The difference in MACCE and mortality between groups seems real, but the early clinical effects have not been observed in other trials 4,14 and require confirmation in large-scale trials. As in the study by Hong et al, 7 an important detail in the present study is the anesthetic regimens used. Propofol was used in 47 RIPC and 32 control patients.…”

Section: Schmidt Et Al Remote Ischemic Preconditioning 1279mentioning

confidence: 87%

“…A more recent and larger study by Hong et al 7 did not show any clinical benefit of RIPC combined with remote ischemic postconditioning in 1280 patients undergoing CABG. The primary end point was a much broader composite of major adverse outcomes than in the study of Thielmann et al 2 and included death, myocardial infarction, arrhythmia, stroke, coma, renal failure or dysfunction, respiratory failure, cardiogenic shock, gastrointestinal complication, and multiorgan failure.…”

mentioning

confidence: 88%

“…Therefore, the differences in the outcomes of the trials are most likely explained by the consequent use of propofol in the latter. Unfortunately, the lack of biomarker assessment in the trial by Hong et al 7 makes it unclear whether any biological effect was evoked by the RIPC treatment.…”

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confidence: 99%

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Remote Ischemic Preconditioning

2013

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During the past 3 decades, several experimental studies have shown that ischemic conditioning reduces myocardial damage by modifying ischemia-reperfusion injury. A recent study in the Lancet indicates that remote ischemic preconditioning translates into clinical benefit in patients undergoing coronary artery bypass surgery. The implications of the study extend to patients undergoing elective and acute coronary angioplasty and beyond.Adjunctive therapies to reduce myocardial ischemiareperfusion injury related to cardiac surgery and percutaneous coronary interventions have yet to find their way into clinical practice, mainly because no pharmacological or mechanical cardioprotective strategy has convincingly shown clinically relevant benefit to the patient.1 That may be about to change. In a recent study by Thielmann et al, 2 329 low-risk patients undergoing elective isolated on-pump first-time coronary artery bypass grafting (CABG) were randomized to either standard CABG or CABG preceded by remote ischemic preconditioning (RIPC), achieved by 3 cycles of 5-minute upper limb ischemia through inflation of a blood pressure cuff followed by 5-minute deflation. The results indicate that RIPC confers a prognostic benefit to the patient.The study was conducted as a single-center, double-blind, randomized, controlled trial. The primary end point was perioperative myocardial injury assessed by troponin I release measured at 6, 12, 24, 48, and 72 hours after surgery. The secondary end points comprised all-cause mortality, major adverse cardiac and cerebrovascular events (MACCE), and repeat revascularization at 30 days, 1 year, and at completion of follow-up, ranging from 1 to >4 years with a mean of 1.54 years. The group demographics were well-matched, and there were no significant differences in baseline risk factors.The authors demonstrated acutely reduced myocardial injury (assessed by troponin I release), as also shown previously by others 3 but, in addition, they also found a reduction in allcause and cardiac mortality, as well as MACCE in the intervention group during the follow-up period. During the follow-up period, MACCE occurred 23 times in the control group versus 8 times in the RIPC group (P=0.011). The authors observed 11 deaths in the control group and only 3 deaths in the RIPC group (P=0.046). The combined end point (death, MACCE, and repeat revascularization) exhibited a hazard ratio of 0.38 (0.21-0.70) in favor of RIPC. There was no difference between groups regarding the need for revascularization.The present study is noteworthy because it is the first to show that the reduction in surrogate end points in patients treated with RIPC before CABG translates into clinical benefit. Although several trials have investigated the effect of RIPC in the context of CABG 3-5 and a recent meta-analysis of these trials indicates that RIPC reduces troponin release in these patients, 6 there is continued skepticism regarding the clinical efficacy of RIPC. In contrast to earlier studies, Thielmann et al 2 conducted a detail...

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Section: Schmidt Et Al Remote Ischemic Preconditioning 1279mentioning

confidence: 87%

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Remote Ischemic Preconditioning

2013

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“…В последние годы опубликованы результаты ряда работ, в которых у больных старше 18 лет оценивалось ренопротекторное действие ДИП без учета характера хирургического вмешатель-ства на сердце, всех пациентов объединяло только использование ИК [55][56][57][58][59]. В исследовании, выполненном в Новой Зеландии, не удалось выявить нефропротекторный эффект ДИП [55].…”

Section: терапевтический архив 8 2016unclassified

“…ОПП выявлено у 27% прекондиционированных больных и у 29% паци-ентов контрольной группы (только хирургическое вмешатель-ство) [55]. Не удалось выявить ренопротекторный эффект ДИП у кардиохирургических больных британским клиницистам [56] и корейским анестезиологам [57]. Неудача постигла L. Candilio и соавт.…”

Section: терапевтический архив 8 2016unclassified

Neuroprotective and nephroprotective effects of remote postconditioning: Prospects for clinical use

Maslov

Tsibulnikov

Цепокина

et al. 2016

Terapevticheskii arkhiv

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1 фГБну «нИИ кардиологии», Томск, россия; 2 национальный исследовательский Томский политехнический университет, Томск, россия; 3 фГБну нИИ комплексных проблем сердечно-сосудистых заболеваний, Кемерово, россия; 4 республиканский научно-прак-тический центр «Кардиология», Минск, Беларусь Аннотация результаты экспериментальных и клинических исследований убедительно свидетельствуют, что дистантное ишемическое прекондиционирование (ДИП) не оказывает нейропротекторного эффекта при кардиохирургических вмешательствах, выполняемых в условиях искусственного кровообращения. Дистантное прекондиционирование (ДК) не оказывает нейро-протекторного эффекта при геморрагическом инсульте. необходимо проведение рандомизированного многоцентрового исследования для оценки эффективности ДИП у пациентов с ишемическим инсультом. ДК снижает выраженность ишеми-ческого и реперфузионного повреждения почки при трансплантации. установлено, что ДИП предупреждает появление нефропатии, индуцированной контрастным веществом. необходимо многоцентровое исследование для оценки эффек-тивности ДИП у пациентов с протезированием аневризмы брюшной аорты. Анализ представленных данных свидетель-ствует, что ДИП не предупреждает возникновение кардиоренального синдрома у новорожденных и детей при выполнении кардиохирургических вмешательств. Данные литературы о способности ДИП оказывать нефропротекторный эффект у пациентов с коронарным шунтированием носят противоречивый характер и свидетельствуют о целесообразности про-ведения многоцентрового исследования. The results of experimental and clinical studies strongly suggest that remote ischemic preconditioning (rIP) has no neuroprotective effect during cardiac surgery performed under extracorporeal circulation. remote preconditioning (rP) has no neuroprotective effect in hemorrhagic stroke. A randomized multicenter study is needed to evaluate the efficiency rIP in patients with ischemic stroke. rP reduces the severity of ischemia/reperfusion kidney injury during transplantation. rIP has been established to prevent contrast-induced nephropathy. There is a need for a multicenter trial to evaluate the efficiency of rIP in patients with abdominal aortic aneurysm repair. Analysis of the presented data indicates that rIP fails to prevent cardiorenal syndrome in infants and children during cardiac surgery. The data available in the literature on the capacity of rIP to provide nephroprotective effect in patients after coronary artery bypass surgery are discordant and indicative of the advisability of a multicenter study. Keywords: remote ischemic preconditioning, brain, kidneys.Дистантное ишемическое прекондиционирование (ДИП) -это феномен повышения устойчивости к длительной ишемии и реперфузии одного органа после кратковременной ишемии-ре-перфузии другого органа. Полагают, что кратковременная ише-мия и реперфузия вызывают выброс в кровоток гуморального фактора(ов), которые повышают толерантность органов и тканей к ишемии и реперфузии [1][2][3][4][5][6][7]. Предполагают, что подобными факторами могут быть эндогенные каннабин...

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Ischaemic preconditioning for the reduction of renal ischaemia reperfusion injury

Menting

Wever

Brunschot

et al. 2017

Cochrane Database of Systematic Reviews

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Remote ischaemic preconditioning by cuff inflation appears to be a safe method, and probably leads to little or no difference in serum creatinine, adverse effects, need for dialysis, length of hospital stay, death and in the incidence of acute kidney injury. Overall we had moderate-high certainty evidence however the available data does not confirm the efficacy of remote ischaemic preconditioning in reducing renal ischaemia reperfusion injury in patients undergoing major cardiac and vascular surgery in which renal ischaemia reperfusion injury may occur.

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Does remote ischaemic preconditioning with postconditioning improve clinical outcomes of patients undergoing cardiac surgery? Remote Ischaemic Preconditioning with Postconditioning Outcome Trial

Abstract: Remote ischaemic preconditioning with RIPostC by transient upper limb ischaemia did not improve clinical outcome in patients who underwent cardiac surgery.

Cited by 105 publications

References 28 publications

Remote Ischemic Preconditioning

Remote Ischemic Preconditioning

Neuroprotective and nephroprotective effects of remote postconditioning: Prospects for clinical use

Ischaemic preconditioning for the reduction of renal ischaemia reperfusion injury

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