Tags

Type your tag names separated by a space and hit enter

Repeated Episodes of Remote Ischemic Preconditioning for the Prevention of Myocardial Injury in Vascular Surgery.
Vasc Endovascular Surg. 2016 Apr; 50(3):140-6.VE

Abstract

OBJECTIVES

Remote ischemic preconditioning (RIPC) involves the phenomenon whereby transient episodes of limb ischemia induced by cuff inflation provide cardioprotection. The effectiveness of RIPC in vascular surgery is uncertain. This randomized, controlled trial was designed to investigate the potential of two episodes of RIPC to provide myocardial protection in patients undergoing vascular surgery.

DESIGN AND METHODS

Patients undergoing an elective major vascular procedure (open abdominal aortic aneurysm (AAA) repair, endovascular aneurysm repair, and lower-limb bypass grafting) were randomized into RIPC group (n = 42) or control group (n = 43). Remote ischemic preconditioning consisted of three 5-minute cycles of upper limb cuff occlusion with 5-minutes of reperfusion between cycles, both 24 hours and immediately before surgery. Control patients received a similarly timed sham treatment. Cardiac high-sensitivity troponin T (hsTnT) concentration was measured in plasma at 6, 12, 24, and 48 hours post-surgery, and at 72, 96, and 120 hours in patients still in hospital. Perioperative clinical adverse events and readmissions within ∼12 months were recorded.

RESULTS

Myocardial injury was demonstrated perioperatively in 43% of RIPC patients and 49% of controls, as defined by a significant hsTnT elevation. These incidences were statistically equivalent (odds ratio 0.79, 95% confidence interval 0.33-1.85, P = .58). The 48-hour area under the curve for hsTnT change from baseline also revealed no difference (RIPC vs control median: 5.3 vs 7.5 ng/L.h, P = .22). Each group had one type I and one type II myocardial infarction and no difference in complications or readmissions.

CONCLUSIONS

This trial could not confirm that two episodes of RIPC reduce myocardial injury following vascular surgery. Along with other equivocal studies, it appears that RIPC does not induce a clear benefit in vascular surgery.

Authors+Show Affiliations

Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand.School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand.Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand andre.vanrij@otago.ac.nz.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

27075990

Citation

Thomas, Kate N., et al. "Repeated Episodes of Remote Ischemic Preconditioning for the Prevention of Myocardial Injury in Vascular Surgery." Vascular and Endovascular Surgery, vol. 50, no. 3, 2016, pp. 140-6.
Thomas KN, Cotter JD, Williams MJ, et al. Repeated Episodes of Remote Ischemic Preconditioning for the Prevention of Myocardial Injury in Vascular Surgery. Vasc Endovascular Surg. 2016;50(3):140-6.
Thomas, K. N., Cotter, J. D., Williams, M. J., & van Rij, A. M. (2016). Repeated Episodes of Remote Ischemic Preconditioning for the Prevention of Myocardial Injury in Vascular Surgery. Vascular and Endovascular Surgery, 50(3), 140-6. https://doi.org/10.1177/1538574416639150
Thomas KN, et al. Repeated Episodes of Remote Ischemic Preconditioning for the Prevention of Myocardial Injury in Vascular Surgery. Vasc Endovascular Surg. 2016;50(3):140-6. PubMed PMID: 27075990.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Repeated Episodes of Remote Ischemic Preconditioning for the Prevention of Myocardial Injury in Vascular Surgery. AU - Thomas,Kate N, AU - Cotter,James D, AU - Williams,Michael J A, AU - van Rij,André M, Y1 - 2016/04/12/ PY - 2016/4/15/entrez PY - 2016/4/15/pubmed PY - 2017/2/22/medline KW - ischemia KW - ischemic preconditioning KW - myocardial ischemic reperfusion injury KW - vascular surgical procedures SP - 140 EP - 6 JF - Vascular and endovascular surgery JO - Vasc Endovascular Surg VL - 50 IS - 3 N2 - OBJECTIVES: Remote ischemic preconditioning (RIPC) involves the phenomenon whereby transient episodes of limb ischemia induced by cuff inflation provide cardioprotection. The effectiveness of RIPC in vascular surgery is uncertain. This randomized, controlled trial was designed to investigate the potential of two episodes of RIPC to provide myocardial protection in patients undergoing vascular surgery. DESIGN AND METHODS: Patients undergoing an elective major vascular procedure (open abdominal aortic aneurysm (AAA) repair, endovascular aneurysm repair, and lower-limb bypass grafting) were randomized into RIPC group (n = 42) or control group (n = 43). Remote ischemic preconditioning consisted of three 5-minute cycles of upper limb cuff occlusion with 5-minutes of reperfusion between cycles, both 24 hours and immediately before surgery. Control patients received a similarly timed sham treatment. Cardiac high-sensitivity troponin T (hsTnT) concentration was measured in plasma at 6, 12, 24, and 48 hours post-surgery, and at 72, 96, and 120 hours in patients still in hospital. Perioperative clinical adverse events and readmissions within ∼12 months were recorded. RESULTS: Myocardial injury was demonstrated perioperatively in 43% of RIPC patients and 49% of controls, as defined by a significant hsTnT elevation. These incidences were statistically equivalent (odds ratio 0.79, 95% confidence interval 0.33-1.85, P = .58). The 48-hour area under the curve for hsTnT change from baseline also revealed no difference (RIPC vs control median: 5.3 vs 7.5 ng/L.h, P = .22). Each group had one type I and one type II myocardial infarction and no difference in complications or readmissions. CONCLUSIONS: This trial could not confirm that two episodes of RIPC reduce myocardial injury following vascular surgery. Along with other equivocal studies, it appears that RIPC does not induce a clear benefit in vascular surgery. SN - 1938-9116 UR - https://www.unboundmedicine.com/medline/citation/27075990/Repeated_Episodes_of_Remote_Ischemic_Preconditioning_for_the_Prevention_of_Myocardial_Injury_in_Vascular_Surgery_ DB - PRIME DP - Unbound Medicine ER -