Remote ischaemic conditioning in percutaneous coronary intervention: a meta-analysis of randomised trials

Abstract

IntroductionIt remains uncertain whether remote ischaemic conditioning (RIC) using cycles of limb ischaemia-reperfusion as a conditioning stimulus benefits patients undergoing percutaneous coronary intervention (PCI).AimWe performed a meta-analysis toassessthe effect of RIC in PCI.Material and methodsThe PubMed, EMBASE, Web of Science, and CENTRAL databases were searched for randomised controlled trials (RCTs) comparing RIC with controls. The treatment effects were measured as a pooled odds ratio (OR), standardised mean difference (SMD), and corresponding 95% confidence intervals (95% CIs) using random-effects models.ResultsFourteen RCTs, including 2,301 patients, were analysed. Compared to the controls, RIC significantly reduced the cardiac enzyme levels (SMD = –0.21; 95% CI: –0.39 to –0.04; p = 0.015; heterogeneity test, I 2 = 75%), and incidence of PCI-related myocardial infarction (OR = 0.70; 95% CI, 0.51–0.98; p = 0.037). There was a trend toward an improvement in the complete ST-segment resolution rate with RIC (OR = 1.83; 95% CI: 0.99–3.40; p = 0.054). No significant difference could be detected between the two groups regarding the risk for acute kidney injury after PCI. Univariate meta-regression analysis suggested that the major source of significant heterogeneity was the PCI type (primary or non-emergent) for the myocardial enzyme levels (adjusted R 2 = 0.44). Subsequent subgroup analysis confirmed the results.ConclusionsThe present meta-analysis showed that RIC could confer cardioprotection for patients undergoing coronary stent implantation. Moreover, the decrease in the myocardial enzyme levels was more pronounced in the patients treated with primary PCI.

Remote ischemic preconditioning protects the spinal cord against ischemic insult: An experimental study in a porcine model

“…The neurons of the spinal cord are better prepared for upcoming ischemia after RIPC, which might be explained by the above-mentioned mechanisms, although they have been studied more extensively in the context of myocardial ischemia. 18,[25][26][27][28] In an experimental model by Donato et al, 26 sectioning of spinal cord extinguished the protective effect of RIPC in the myocardium, indicating the involvement of neuronal afferent signaling. Therefore, we took extra precautions to not damage the femoral nerve while operating on the right femoral vessels.…”

Effect of Remote Ischemic Preconditioning on Perioperative Cardiac Events in Patients Undergoing Elective Percutaneous Coronary Intervention: A Meta-Analysis of 16 Randomized Trials

“…Many clinical observations have found that increased levels of myocardial injury markers, such as troponin T, troponin I, and CK-MB, are associated with adverse long-term prognosis after elective percutaneous coronary intervention [ 41 , 46 , 47 ]. In the meta-analysis by Niu et al [ 48 ], it was found that RIPC can reduce myocardial injury markers after PCI release; this protective effect was more obvious in STEMI patients, while in the elective PCI patients, RIPC cannot reduce myocardial injury markers, and the heterogeneity of the included studies was larger. To our knowledge, this is the first meta-analysis to explore whether RIPC could reduce the release of myocardial markers after PCI in patients with elective PCI.…”

The impact of a single episode of remote ischemic preconditioning on myocardial injury after elective percutaneous coronary intervention

“…Unlike the studies of classical preconditioning, Liu et al demonstrated that late RIPC also had beneficial effects on patients undergoing elective PCI [29]. Although there is heterogeneity in RIPC protocols, meta-analyses of the major RIPC studies in elective PCI indicated that ischemic preconditioning had beneficial effects on post-PCI myocardial injury [31–33]. …”