Effects of Remote Ischemic Preconditioning With Postconditioning in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery

Hong, Deok Man; Jeon, Yunseok; Lee, Chang Soon; Kim, Hyun Joo; Lee, Jung Man; Bahk, Jae Hyon; Kim, Ki-Bong; Hwang, Ho Young

doi:10.1253/circj.cj-11-1068

Cited by 63 publications

(62 citation statements)

References 35 publications

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“…The condition of patients with a history of ACS could reflect the experimental model of MI developing tolerance to prolonged ischemic insult, namely ischemic preconditioning when the myocardium has been previously exposed to brief periods of ischemia and reperfusion [35]. Some experimental studies have investigated the effect of ischemic preconditioning on necrosis markers and the potential clinical interpretation [36][37][38]. Basically, in MI patients undergoing myocardial revascularization ischemic preconditioning was reported to reduce periprocedural cTn concentrations and to delay myocardial necrosis [36].…”

Section: Discussionmentioning

confidence: 99%

New insights in the pathophysiology of acute myocardial infarction detectable by a contemporary troponin assay

Ferraro

Biganzoli

Marano

et al. 2013

Clinical Biochemistry

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Objectives: ST-elevation and non-ST-elevation myocardial infarction (STEMI, NSTEMI) are considered two distinct pathophysiologic entities. We evaluated cardiac troponin I (cTnI) release in STEMI and NSTEMI using a "contemporary" (CV > 10 to 20% at the 99th percentile concentration) cTnI assay for patients undergoing early percutaneous coronary intervention (PCI).Design and methods: 856 patients with suspected acute coronary syndrome consecutively admitted to the Emergency Department of the Maggiore Hospital of Novara (225 STEMI and 135 NSTEMI) were selected according to: 1) early (≤4 h from admission) and successful PCI; and 2) cTnI measurements at ED presentation and within 24 h. The influence of the MI type on cTnI concentrations at baseline and after PCI as well as the velocity of cTnI [cTnI V = absolute increase (after log conversion of cTnI measurements) / delay between the two measurements] was studied by multiple regression analysis, adjusting for patient parameters.Results: A statistically significant interaction between MI type and time from symptoms was reported on cTnI concentrations (p b 0.0001): STEMI and NSTEMI differed for cTnI releases at admission and after revascularization. Higher cTnI V in STEMI was detectable in patients admitted within 6 h from symptoms. Baseline cTnI concentrations were lower in patients with a history of coronary artery disease (CAD) and increased with aging (p b 0.0001). In the elderly (>75 years), the cTnI V was significantly increased.Conclusion: STEMI and NSTEMI patients have different patterns and dynamics of cTnI release influenced by the interaction with time from symptoms, by aging and history of CAD.

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Section: Discussionmentioning

confidence: 99%

New insights in the pathophysiology of acute myocardial infarction detectable by a contemporary troponin assay

Ferraro

Biganzoli

Marano

et al. 2013

Clinical Biochemistry

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“…They randomly assigned 70 patients having off‐pump CABG to a combination of RIPreC and RIPostC in one group, and controls in the other. This resulted in a 48.7% reduction in peri‐operative injury, as determined by the 72‐h troponin area under the curve 116. However, in a larger trial by this group including 1280 patients, RIPreC and RIPostC together did not reduce a composite endpoint of major adverse outcomes, which included death, MI, arrhythmia, stroke, coma, renal failure or dysfunction, respiratory failure, cardiogenic shock, gastrointestinal complication and multi‐organ failure 76.…”

Section: Other Forms Of Ricmentioning

confidence: 99%

Remote ischaemic conditioning: cardiac protection from afar

2015

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For patients with ischaemic heart disease, remote ischaemic conditioning may offer an innovative, non‐invasive and virtually cost‐free therapy for protecting the myocardium against the detrimental effects of acute ischaemia‐reperfusion injury, preserving cardiac function and improving clinical outcomes. The intriguing phenomenon of remote ischaemic conditioning was first discovered over 20 years ago, when it was shown that the heart could be rendered resistant to acute ischaemia‐reperfusion injury by applying one or more cycles of brief ischaemia and reperfusion to an organ or tissue away from the heart – initially termed ‘cardioprotection at a distance’. Subsequent pre‐clinical and then clinical studies made the important discovery that remote ischaemic conditioning could be elicited non‐invasively, by inducing brief ischaemia and reperfusion to the upper or lower limb using a cuff. The actual mechanism underlying remote ischaemic conditioning cardioprotection remains unclear, although a neuro‐hormonal pathway has been implicated. Since its initial discovery in 1993, the first proof‐of‐concept clinical studies of remote ischaemic conditioning followed in 2006, and now multicentre clinical outcome studies are underway. In this review article, we explore the potential mechanisms underlying this academic curiosity, and assess the success of its application in the clinical setting.

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“…Finally, fifteen papers were found to present the best available evidence. These studies pertained to: adult coronary bypass grafting surgery with or without AVR [9,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27], adult valvular surgery [28][29][30], and pediatric cardiac surgery [31][32][33]. All the available papers were designed as prospective randomized controlled trials.…”

Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

“…Male gender proportion ranged from 35% to 100% in the rIPC group and from 28% to 100% among the controls. The majority of patients were operated on due to coronary artery disease (335 in the rIPC group and 340 in the control group) [9,[20][21][22][23][24][25][26][27]. The analysis of rIPC in pediatric patients undergoing cardiac surgery included 67 patients in the rIPC study groups and 70 in the control groups [31][32][33], whereas 89 and 90 patients were submitted to isolated valvular surgery with or without rIPC, respectively [28][29][30].…”

Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

“…The analysis of rIPC in pediatric patients undergoing cardiac surgery included 67 patients in the rIPC study groups and 70 in the control groups [31][32][33], whereas 89 and 90 patients were submitted to isolated valvular surgery with or without rIPC, respectively [28][29][30]. All studies were proof-of-concept trials with small sample sizes, and only three included more than 100 patients [20][21][22]. Diabetic subjects were partially included in six trials [9,[21][22][23][24]30].…”

Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

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Experimental cardiovascular and lung research Remote ischemic preconditioning versus standard myocardial protection in cardiac surgery: ten years of clinical trials. A systematic review and meta-analysis

Marczak¹,

Bańkowski²,

Płonek³

et al. 2013

kitp

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StreszczenieCelem niniejszej metaanalizy jest systematyczny przegląd dowodów obrazujących wpływ odległego hartowania niedokrwiennego (rIPC) na mięsień serca pacjentów poddanych operacjom kardiochirurgicznym. Materiały i metody: Przeglądu literatury dokonano na podstawie pełnotekstowych prac publikowanych w bazach danych Medline, Cochrane itp. Włączono badania kontrolowane z randomizacją, porównujące rIPC oraz standardową ochronę mięśnia serca u pacjentów poddanych zabiegom kardiochirurgicznym, jeżeli raportowały co najmniej jeden z wyników: markery uszkodzenia mięśnia sercowego, pooperacyjne zapotrzebowanie na leki wykazujące dodatni efekt inotropowy, czas hospitalizacji na oddziale intensywnej terapii. 268 EXPERIMENTAL CARDIOVASCULAR AND LUNG RESEARCH SummaryObjectives: To systematically review and assess the existing evidence for the applicability of remote ischemic preconditioning (rIPC) in cardiac surgery. Material and methods: Major biomedical databases: Medline, Cochrane, etc. were searched. All randomized controlled trials (RCTs) comparing rIPC and standard myocardial protection in patients submitted to cardiac surgery were included if they reported at least one of the outcomes of interest: myocardial injury markers, postoperative inotropic support, or length of ICU stay. Results: 991 patients were included in the analysis. rIPC was shown to reduce myocardial injury markers postoperatively by -0.63 SMD [-0.99 to -0.28] and postoperative inotropic requirement by -0.40 SMD [-0.66 to -0.16] in the adult patients submitted to cardiac surgery. There has been significant, yet correctable, heterogeneity of the primary outcome of interest, and the available RCTs were small sample studies. Conclusions: This meta-analysis provides evidence confirming that rIPC has potential benefits with regard to myocardial protection.

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Effects of Remote Ischemic Preconditioning With Postconditioning in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery

Cited by 63 publications

References 35 publications

New insights in the pathophysiology of acute myocardial infarction detectable by a contemporary troponin assay

New insights in the pathophysiology of acute myocardial infarction detectable by a contemporary troponin assay

Remote ischaemic conditioning: cardiac protection from afar

Experimental cardiovascular and lung research Remote ischemic preconditioning versus standard myocardial protection in cardiac surgery: ten years of clinical trials. A systematic review and meta-analysis

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