Remote ischaemic pre-conditioning does not affect clinical outcomes following coronary Artery bypass grafting. A systematic review and meta-analysis

Abstract

Background

Trials of remote ischemic pre-conditioning (RIPC) have suggested this intervention reduces complications of angioplasty and coronary artery by-pass grafting (CABG). The aim of this work was to conduct a systematic review and meta-analysis of the effects of RIPC on mortality and myocardial damage in patients undertaking coronary artery bypass grafting with/without valve surgery.

Methods

A systematic review and subsequent meta-analysis of randomized controlled trials of RIPC versus usual care or sham RIPC was performed.

Results

Eighteen studies, totalling 4551 participants were analysed. RIPC reduced post troponin release as indicated by area under the curve at 72 h (μg·L^− 1) Mean Difference (MD) − 3.72 (95% CI − 3.92 to − 3.53, p < 0.00001). However there was no significant difference between RIPC and control when mortality odds ratio (OR) 1.27 (95% CI 0.87 to 1.86, p = 0.22); the incidence of new onset atrial fibrillation OR 0.82 (95% CI 0.67 to 1.01, p = 0.06); inotropic support OR 1.27 (95% CI 0.84 to 1.91, p = 0.25); intensive care unit stay in days MD − 0.02 (95% CI − 0.12 to 0.07, p = 0.61); Hospital stay in days MD 0.18 (95% CI − 0.30 to 0.66, p = 0.47) and serum creatinine MD − 0.00 (95% CI − 0.07 to 0.07, p = 0.97) were compared.

Conclusions

RIPC reduces does not confer any clinical benefit in patients undertaking CABG with/without valve surgery.