Remote ischaemic preconditioning reduces myocardial injury in patients undergoing cardiac surgery with cold-blood cardioplegia: a randomised controlled trial

Venugopal, Vinod; Hausenloy, Derek J.; Ludman, Andrew; Salvo, Carmelo Di; Kolvekar, Shyam; Yap, John; Lawrence, David; Bognolo, J; Yellon, Derek M.

doi:10.1136/hrt.2008.155770

Cited by 207 publications

(150 citation statements)

References 33 publications

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“…Subgroup analysis of the studies reporting outcomes of CABG with or without AVR showed results consistent with the general trend (SMD -0.42; 95% CI: -0.70 to -0.13, p = 0.005) and I 2 = 67% [9,[20][21][22][23][24][25][26][27]. Studies concerning isolated valvular surgery did not confirm the protective result of rIPC; however, heterogeneity (I 2 = 94%) was essentially influencing the outcome effect under the random [28][29][30].…”

Section: Sensitivity Analysismentioning

confidence: 58%

“…This correction changed the heterogeneity from 83% to 0% and the effect was still highly significant (SMD -0.69; 95% CI: -0.86 to -0.51; p = 0.00001). With regard to studies scoring > 5 points on the Jadad scale, the meta-analysis showed a significant reduction of necrosis markers, although the effect was smaller than the effect for the whole population (SMD -0.40; 95% CI: -0.69 to -0.11; p = 0.005) [9,20,21,[23][24][25][26]30]. We analyzed the effect of rIPC on diabetic patients separately, and compared it with trials in which Remote ischemic preconditioning versus standard myocardial protection in cardiac surgery: ten years of clinical trials.…”

Section: Experimental Cardiovascular and Lung Researchmentioning

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%

“…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%

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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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Section: Sensitivity Analysismentioning

confidence: 58%

Section: Experimental Cardiovascular and Lung Researchmentioning

confidence: 99%

Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

See 2 more Smart Citations

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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“…Mid-scale clinical studies have shown that RIC applied prior to CABG [39,81] and PCI [38] reduces surrogate markers of myocardial injury, but until recently, the clinical relevance of these findings was questionable. However, two recent publications strongly suggest, that RIC should find a place as standard adjunctive therapy in elective PCI and CABG.…”

Section: Remote Ischemic Conditioning In Predictable Ischemiamentioning

confidence: 99%

Novel adjunctive treatments of myocardial infarction

Schmidt

Pryds

Bøtker

2014

WJC

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Myocardial infarction is a major cause of death and disability worldwide and myocardial infarct size is a major determinant of prognosis. Early and successful restoration of myocardial reperfusion following an ischemic event is the most effective strategy to reduce final infarct size and improve clinical outcome, but reperfusion may induce further myocardial damage itself. Development of adjunctive therapies to limit myocardial reperfusion injury beyond opening of the coronary artery gains increasing attention. A vast number of experimental studies have shown cardioprotective effects of ischemic and pharmacological conditioning, but despite decades of research, the translation into clinical effects has been challenging. Recently published clinical studies, however, prompt optimism as novel techniques allow for improved clinical applicability. Cyclosporine A, the GLP-1 analogue exenatide and rapid cooling by endovascular infusion of cold saline all reduce infarct size and may confer clinical benefit for patients admitted with acute myocardial infarcts. Equally promising, three follow-up studies of the effect of remote ischemic conditioning (RIC) show clinical prognostic benefit in patients undergoing coronary surgery and percutaneous coronary intervention. The discovery that RIC can be performed noninvasively using a blood pressure cuff on the upper arm to induce brief episodes of limb ischemia and reperfusion has facilitated the translation of RIC into the clinical arena. This review focus on novel advances in adjunctive therapies in relation to acute and elective coronary procedures.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Myocardial infarction; Primary percutaneous intervention; Coronary artery by-pass graft; Ischemiareperfusion injury; Ischemic preconditioning; Remote ischemic conditioning; Cyclosporine; Cooling; Exenatide Core tip: Patients with ischemic heart disease have a high risk of developing myocardial infarction, which is associated with considerable morbidity and mortality. Limiting the detrimental consequences of myocardial infarction is a major focus of cardiovascular research. Recent clinical studies suggest that novel adjunctive therapy with pharmacological and ischemic conditioning reduce ischemia-reperfusion injury in patients during coronary procedures. In three independent randomized trials, remote ischemic conditioning (RIC) improves clinical outcome in patients undergoing acute or elective percutaneous intervention or coronary artery bypass surgery. RIC can be performed safely and noninvasively by intermittent inflation of a blood-pressure cuff on the upper arm and is easily applicable in most clinical settings. worldwide [1,2] . Since 1990, more people have died from coronary artery disease than any other death cause [3,4] . In China, a staggering 230 million are estimated to suffer from cardiovascular disease, and three million Chinese die of cardiovascular disease annually, accounting for 41% of all deaths [5,6] . In the United States alone, cardiov...

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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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Remote ischaemic preconditioning reduces myocardial injury in patients undergoing cardiac surgery with cold-blood cardioplegia: a randomised controlled trial

Cited by 207 publications

References 33 publications

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

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

Novel adjunctive treatments of myocardial infarction

Ischaemic preconditioning for the reduction of renal ischaemia reperfusion injury

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