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Remote Ischemic Preconditioning in High-risk Cardiovascular Surgery Patients: A Randomized-controlled Trial.
Semin Thorac Cardiovasc Surg. 2018 Spring; 30(1):26-33.ST

Abstract

Remote ischemic preconditioning (RIPC) may reduce biomarkers of ischemic injury after cardiovascular surgery. However, it is unclear whether RIPC has a positive impact on clinical outcomes. We performed a blinded, randomized controlled trial to determine if RIPC resulted in fewer adverse clinical outcomes after cardiac or vascular surgery. The intervention consisted of 3 cycles of RIPC on the upper limb for 5 minutes alternated with 5 minutes of rest. A sham intervention was performed on the control group. Patients were recruited who were undergoing (1) high-risk cardiac or vascular surgery or (2) cardiac or vascular surgery and were at high risk of ischemic complications. The primary end point was a composite outcome of mortality, myocardial infarction, stroke, renal failure, respiratory failure, and low cardiac output syndrome, and the secondary end points included the individual outcome parameters that made up this score, as well as troponin-I values. A total of 436 patients were randomized and analysis was performed on 215 patients in the control group and on 213 patients in the RIPC group. There were no differences in the composite outcome between the 2 groups (RIPC: 67 [32%] and control: 72 [34%], relative risk [0.94 {0.72-1.24}]) or in any of the individual components that made up the composite outcome. Additionally, we did not observe any differences between the groups in troponin-I values, the length of intensive care unit stay, or the total hospital stay. RIPC did not have a beneficial effect on clinical outcomes in patients who had cardiovascular surgery.

Authors+Show Affiliations

Department of Surgery, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada.Department of Surgery, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada.Department of Surgery, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada.Department of Surgery, Libin Cardiovascular Institute of Alberta, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada.Department of Medicine, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada.Department of Anesthesiology and Perioperative Medicine, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada.Department of Anesthesiology and Perioperative Medicine, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada.Department of Surgery, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada.Department of Surgery, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada.Department of Surgery, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada. Electronic address: payned@kgh.kari.net.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

29055710

Citation

Coverdale, Nicole S., et al. "Remote Ischemic Preconditioning in High-risk Cardiovascular Surgery Patients: a Randomized-controlled Trial." Seminars in Thoracic and Cardiovascular Surgery, vol. 30, no. 1, 2018, pp. 26-33.
Coverdale NS, Hamilton A, Petsikas D, et al. Remote Ischemic Preconditioning in High-risk Cardiovascular Surgery Patients: A Randomized-controlled Trial. Semin Thorac Cardiovasc Surg. 2018;30(1):26-33.
Coverdale, N. S., Hamilton, A., Petsikas, D., McClure, R. S., Malik, P., Milne, B., Saha, T., Zelt, D., Brown, P., & Payne, D. M. (2018). Remote Ischemic Preconditioning in High-risk Cardiovascular Surgery Patients: A Randomized-controlled Trial. Seminars in Thoracic and Cardiovascular Surgery, 30(1), 26-33. https://doi.org/10.1053/j.semtcvs.2017.09.001
Coverdale NS, et al. Remote Ischemic Preconditioning in High-risk Cardiovascular Surgery Patients: a Randomized-controlled Trial. Semin Thorac Cardiovasc Surg. 2018;30(1):26-33. PubMed PMID: 29055710.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Remote Ischemic Preconditioning in High-risk Cardiovascular Surgery Patients: A Randomized-controlled Trial. AU - Coverdale,Nicole S, AU - Hamilton,Andrew, AU - Petsikas,Dimitri, AU - McClure,R Scott, AU - Malik,Paul, AU - Milne,Brian, AU - Saha,Tarit, AU - Zelt,David, AU - Brown,Peter, AU - Payne,Darrin M, Y1 - 2017/09/11/ PY - 2017/09/05/accepted PY - 2017/10/23/pubmed PY - 2018/10/10/medline PY - 2017/10/23/entrez KW - cardiovascular surgery KW - ischemia-reperfusion KW - remote ischemic preconditioning SP - 26 EP - 33 JF - Seminars in thoracic and cardiovascular surgery JO - Semin. Thorac. Cardiovasc. Surg. VL - 30 IS - 1 N2 - Remote ischemic preconditioning (RIPC) may reduce biomarkers of ischemic injury after cardiovascular surgery. However, it is unclear whether RIPC has a positive impact on clinical outcomes. We performed a blinded, randomized controlled trial to determine if RIPC resulted in fewer adverse clinical outcomes after cardiac or vascular surgery. The intervention consisted of 3 cycles of RIPC on the upper limb for 5 minutes alternated with 5 minutes of rest. A sham intervention was performed on the control group. Patients were recruited who were undergoing (1) high-risk cardiac or vascular surgery or (2) cardiac or vascular surgery and were at high risk of ischemic complications. The primary end point was a composite outcome of mortality, myocardial infarction, stroke, renal failure, respiratory failure, and low cardiac output syndrome, and the secondary end points included the individual outcome parameters that made up this score, as well as troponin-I values. A total of 436 patients were randomized and analysis was performed on 215 patients in the control group and on 213 patients in the RIPC group. There were no differences in the composite outcome between the 2 groups (RIPC: 67 [32%] and control: 72 [34%], relative risk [0.94 {0.72-1.24}]) or in any of the individual components that made up the composite outcome. Additionally, we did not observe any differences between the groups in troponin-I values, the length of intensive care unit stay, or the total hospital stay. RIPC did not have a beneficial effect on clinical outcomes in patients who had cardiovascular surgery. SN - 1532-9488 UR - https://www.unboundmedicine.com/medline/citation/29055710/Remote_Ischemic_Preconditioning_in_High_risk_Cardiovascular_Surgery_Patients:_A_Randomized_controlled_Trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1043-0679(17)30238-1 DB - PRIME DP - Unbound Medicine ER -