Remote ischemic preconditioning and its role in the prevention of new onset atrial fibrillation post‐cardiac surgery. A meta‐analysis of randomized control trials

Kumar, Ashish; Singh, Harpreet; Shariff, Mariam

doi:10.1002/joa3.12252

Cited by 6 publications

(6 citation statements)

References 24 publications

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“…In this study, we synthesized the current evidence from RCTs and showed that RIPC is effective for preventing AKI after cardiac surgery. Besides the potential preventative efficacy on AKI, previous studies have shown that RIPC is also effective to attenuate perioperative myocardial injury ( 43 ) and reduce the risk of new onset atrial fibrillation ( 44 ) in patients undergoing cardiac surgery and may reduce mortality in patients receiving volatile inhalational agent anesthesia ( 34 ). Taken together, these findings support the benefits of RIPC use for patients undergoing cardiac surgeries.…”

Section: Discussionmentioning

confidence: 99%

Remote Ischemic Preconditioning to Prevent Acute Kidney Injury After Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials

Zigang

Yong-mei

Lei

et al. 2021

Front. Cardiovasc. Med.

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Objective: Randomized controlled trials (RCTs) evaluating the influence of remote ischemic preconditioning (RIPC) on acute kidney injury (AKI) after cardiac surgery showed inconsistent results. We performed a meta-analysis to evaluate the efficacy of RIPC on AKI after cardiac surgery.Methods: Relevant studies were obtained by search of PubMed, Embase, and Cochrane's Library databases. A random-effect model was used to pool the results. Meta-regression and subgroup analyses were used to determine the source of heterogeneity.Results: Twenty-two RCTs with 5,389 patients who received cardiac surgery −2,702 patients in the RIPC group and 2,687 patients in the control group—were included. Moderate heterogeneity was detected (p for Cochrane's Q test = 0.03, I2 = 40%). Pooled results showed that RIPC significantly reduced the incidence of AKI compared with control [odds ratio (OR): 0.76, 95% confidence intervals (CI): 0.61–0.94, p = 0.01]. Results limited to on-pump surgery (OR: 0.78, 95% CI: 0.64–0.95, p = 0.01) or studies with acute RIPC (OR: 0.78, 95% CI: 0.63–0.97, p = 0.03) showed consistent results. Meta-regression and subgroup analyses indicated that study characteristics, including study design, country, age, gender, diabetic status, surgery type, use of propofol or volatile anesthetics, cross-clamp time, RIPC protocol, definition of AKI, and sample size did not significantly affect the outcome of AKI. Results of stratified analysis showed that RIPC significantly reduced the risk of mild-to-moderate AKI that did not require renal replacement therapy (RRT, OR: 0.76, 95% CI: 0.60–0.96, p = 0.02) but did not significantly reduce the risk of severe AKI that required RRT in patients after cardiac surgery (OR: 0.73, 95% CI: 0.50–1.07, p = 0.11).Conclusions: Current evidence supports RIPC as an effective strategy to prevent AKI after cardiac surgery, which seems to be mainly driven by the reduced mild-to-moderate AKI events that did not require RRT. Efforts are needed to determine the influences of patient characteristics, procedure, perioperative drugs, and RIPC protocol on the outcome.

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Section: Discussionmentioning

confidence: 99%

Remote Ischemic Preconditioning to Prevent Acute Kidney Injury After Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials

Zigang

Yong-mei

Lei

et al. 2021

Front. Cardiovasc. Med.

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“…We did not have access to detailed information regarding potential medical treatment (anticoagulation and/or rate control), since these data are not registered in the Danish National Patient Registry. A recent meta‐analysis did not find any effect of RIPC on the risk of postoperative atrial fibrillation [26]. However, future clinical trials should register this potential adverse effect of RIPC in relation to non‐cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular events in patients undergoing hip fracture surgery treated with remote ischaemic preconditioning: 1‐year follow‐up of a randomised clinical trial

et al. 2021

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Summary Remote ischaemic preconditioning reduces the risk of myocardial injury within 4 days of hip fracture surgery. We aimed to investigate the effect of remote ischaemic preconditioning on the incidence of major adverse cardiovascular events 1 year after hip fracture surgery. We performed a phase‐2, multicentre, randomised, observer‐blinded, clinical trial between February 2015 and September 2017. We studied patients aged ≥ 45 years with a hip fracture and a minimum of one cardiovascular risk factor. Patients were allocated randomly to remote ischaemic preconditioning applied just before surgery or no treatment (control group). Remote ischaemic preconditioning was performed on the upper arm with a tourniquet in four cycles of 5 min ischaemia and 5 min reperfusion. Primary outcome was the occurrence of major adverse cardiovascular events within 1 year of surgery. A total of 316 patients were allocated randomly to the remote ischaemic preconditioning group and 309 patients to the control group. Major adverse cardiovascular events occurred in 43 patients (13.6%) in the remote ischaemic preconditioning group compared with 51 patients (16.5%) in the control group (adjusted hazard ratio (95%CI) 0.83 (0.55–1.25); p = 0.37). Fewer patients in the remote ischaemic preconditioning group had a myocardial infarction (11 (3.5%) vs. 22 (7.1%); hazard ratio (95%CI) 0.48 (CI 0.23–1.00); p = 0.04). Remote ischaemic preconditioning did not reduce the occurrence of major adverse cardiovascular events within 1 year of hip fracture surgery. The effect of remote ischaemic preconditioning on clinical cardiovascular outcomes in non‐cardiac surgery needs confirmation in appropriately powered randomised clinical trials.

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“…Experiments using pigs and rats showed that a vago-splenic axis was involved in the cardioprotection of RIPC [25]. Substances such as adenosine [26], bradykinin, opioids [27], microvesicles [28], microRNA-144 [29], nitric oxide [30,31], interleukin (IL)-10 [32] and stromal cell-derived atrial fibrillation post-cardiac surgery seems to be more confirmative [14]. In the meantime, there is also a growing interest in understanding non-anesthetic effects of narcotics [15].…”

Section: Myocardial Ischemia and Reperfusion Injurymentioning

confidence: 99%

Remote Ischemic Preconditioning for Cardioprotection in Patients Undergoing Cardiac Surgery: A Systemic Review

Wang¹,

Xiao-dong²,

Wei³

et al. 2020

Transl Perioper & Pain Med

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A short period of sublethal ischemia can provide cardioprotection against ischemia/reperfusion injury. As direct application of ischemic to the heart is impractical, remote ischemic preconditioning (RIPC) is usually preferred. The mechanism through which the cardioprotective effect is transferred from the remote organ or tissue to the heart remains unclear. Neurogenic, hormonal, and systemic factors have been proposed. Although RIPC has been applied in clinic with different modes, its effect on major cardiac outcomes, especially among diabetic patients, is still controversial. Therefore, further studies are still needed to identify its exact role in clinical practice and also investigate more specific mechanisms.Accordingly, remote ischemic preconditioning (RIPC)

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Remote ischemic preconditioning and its role in the prevention of new onset atrial fibrillation post‐cardiac surgery. A meta‐analysis of randomized control trials

Cited by 6 publications

References 24 publications

Remote Ischemic Preconditioning to Prevent Acute Kidney Injury After Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials

Remote Ischemic Preconditioning to Prevent Acute Kidney Injury After Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials

Cardiovascular events in patients undergoing hip fracture surgery treated with remote ischaemic preconditioning: 1‐year follow‐up of a randomised clinical trial

Remote Ischemic Preconditioning for Cardioprotection in Patients Undergoing Cardiac Surgery: A Systemic Review

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