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Int J Cardiol. 2014 Sep;176(1):20-31. doi: 10.1016/j.ijcard.2014.06.018. Epub 2014 Jun 27.

Remote preconditioning and major clinical complications following adult cardiovascular surgery: systematic review and meta-analysis.

Author information

1
University of Limerick, Ireland. Electronic address: donagh1@hotmail.com.
2
University of Limerick, Ireland.
3
National University of Ireland Galway, Ireland.
4
Addenbrooke's Hospital, Cambridge, United Kingdom.
5
Central South University, Hunan, China.
6
Hatter Cardiovascular Institute, University College London, United Kingdom.
7
Maine Medical Centre, ME, United States.
8
Novosibirsk State Research Institute of Circulation Pathology, Novosibirsk, Russia.
9
Queen Elizabeth Medical Centre, Birmingham, United Kingdom.
10
Seoul National University Hospital, Seoul, South Korea.
11
St. Anne's University Hospital, Brno, Czech Republic.
12
University Hospital Essen, Essen, Germany.
13
University Hospital Frankfurt, Germany.
14
University Hospital Frankfurt, Germany; University Hospital Schleswig-Holstein, Kiel, Germany.
15
University Hospital Schleswig-Holstein, Kiel, Germany.
16
Changi General Hospital, Singapore.

Abstract

BACKGROUND:

A number of 'proof-of-concept' trials suggest that remote ischaemic preconditioning (RIPC) reduces surrogate markers of end-organ injury in patients undergoing major cardiovascular surgery. To date, few studies have involved hard clinical outcomes as primary end-points.

METHODS:

Randomised clinical trials of RIPC in major adult cardiovascular surgery were identified by a systematic review of electronic abstract databases, conference proceedings and article reference lists. Clinical end-points were extracted from trial reports. In addition, trial principal investigators provided unpublished clinical outcome data.

RESULTS:

In total, 23 trials of RIPC in 2200 patients undergoing major adult cardiovascular surgery were identified. RIPC did not have a significant effect on clinical end-points (death, peri-operative myocardial infarction (MI), renal failure, stroke, mesenteric ischaemia, hospital or critical care length of stay).

CONCLUSION:

Pooled data from pilot trials cannot confirm that RIPC has any significant effect on clinically relevant end-points. Heterogeneity in study inclusion and exclusion criteria and in the type of preconditioning stimulus limits the potential for extrapolation at present. An effort must be made to clarify the optimal preconditioning stimulus. Following this, large-scale trials in a range of patient populations are required to ascertain the role of this simple, cost-effective intervention in routine practice.

KEYWORDS:

Cardioprotection; Cardiovascular surgery; Ischaemic preconditioning; Remote ischaemic preconditioning; Systematic review

PMID:
25022819
DOI:
10.1016/j.ijcard.2014.06.018
[Indexed for MEDLINE]
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