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Remote ischemic conditioning in percutaneous coronary intervention and coronary artery bypass grafting

Tuncay Yetgin1, Olivier C Manintveld, Eric Boersma

  • 1Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Dr. Molewaterplein 50-60, 3015 GE Rotterdam, The Netherlands.

Circulation Journal : Official Journal of the Japanese Circulation Society
|July 13, 2012
PubMed

Insights

Remote ischemic conditioning (RIC) may reduce myocardial injury biomarkers in patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). While significant effects were seen in primary PCI and CABG, overall PCI results lacked statistical significance.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Ischemia-Reperfusion Injury

Background:

  • Remote ischemic conditioning (RIC) shows potential for mitigating myocardial injury during PCI and CABG.
  • Recent clinical trials present conflicting outcomes regarding RIC's efficacy.
  • This meta-analysis evaluates RIC's impact on myocardial injury biomarkers in PCI and CABG patients.

Purpose of the Study:

  • To systematically assess the effectiveness of RIC in reducing myocardial injury.
  • To analyze RIC's impact specifically in percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) procedures.

Main Methods:

  • A meta-analysis of randomized controlled trials investigating RIC in PCI or CABG.
  • Inclusion criteria required reporting of myocardial injury biomarkers (CK-MB, troponin T/I).
  • Standardized mean differences (SMDs) were calculated using the Hedges g statistic.

Main Results:

  • Overall PCI analysis (4 studies, 557 patients) showed a non-significant reduction in injury biomarkers (SMD: -0.21, CI: -0.66 to 0.24).
  • Primary PCI subgroup analysis (314 patients) demonstrated a significant protective effect (SMD: -0.55, CI: -0.77 to -0.32).
  • CABG analysis (13 studies, 891 patients) revealed a significant reduction in myocardial injury biomarkers (SMD: -0.34, CI: -0.59 to -0.08).
  • Moderate to high heterogeneity was observed across studies for both PCI and CABG.

Conclusions:

  • RIC is associated with lower myocardial injury biomarkers in PCI and CABG patients.
  • The beneficial effect of RIC did not achieve statistical significance in the overall PCI patient group.
  • RIC demonstrates a significant protective effect in primary PCI and CABG procedures.
Abstract

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