{"title":"远程缺血预处理不影响冠状动脉旁路移植术后的临床结果。系统回顾和荟萃分析","authors":"Nicola King , Gudrun Dieberg , Neil A. Smart","doi":"10.1016/j.ctrsc.2016.03.001","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>A systematic review and subsequent meta-analysis of randomized controlled trials of RIPC versus usual care or sham RIPC was performed.</p></div><div><h3>Results</h3><p>Eighteen studies, totalling 4551 participants were analysed. RIPC reduced post troponin release as indicated by area under the curve at 72<!--> <!-->h (μg·L<sup>−<!--> <!-->1</sup>) 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.</p></div><div><h3>Conclusions</h3><p>RIPC reduces does not confer any clinical benefit in patients undertaking CABG with/without valve surgery.</p></div>","PeriodicalId":91232,"journal":{"name":"Clinical trials and regulatory science in cardiology","volume":"17 ","pages":"Pages 1-8"},"PeriodicalIF":0.0000,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ctrsc.2016.03.001","citationCount":"9","resultStr":"{\"title\":\"Remote ischaemic pre-conditioning does not affect clinical outcomes following coronary Artery bypass grafting. A systematic review and meta-analysis\",\"authors\":\"Nicola King , Gudrun Dieberg , Neil A. Smart\",\"doi\":\"10.1016/j.ctrsc.2016.03.001\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>A systematic review and subsequent meta-analysis of randomized controlled trials of RIPC versus usual care or sham RIPC was performed.</p></div><div><h3>Results</h3><p>Eighteen studies, totalling 4551 participants were analysed. RIPC reduced post troponin release as indicated by area under the curve at 72<!--> <!-->h (μg·L<sup>−<!--> <!-->1</sup>) 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.</p></div><div><h3>Conclusions</h3><p>RIPC reduces does not confer any clinical benefit in patients undertaking CABG with/without valve surgery.</p></div>\",\"PeriodicalId\":91232,\"journal\":{\"name\":\"Clinical trials and regulatory science in cardiology\",\"volume\":\"17 \",\"pages\":\"Pages 1-8\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2016-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1016/j.ctrsc.2016.03.001\",\"citationCount\":\"9\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical trials and regulatory science in cardiology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2405587516300099\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical trials and regulatory science in cardiology","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2405587516300099","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 9
摘要
远程缺血预处理(RIPC)的试验表明,这种干预可以减少血管成形术和冠状动脉旁路移植术(CABG)的并发症。本研究的目的是对RIPC对冠状动脉搭桥术合并/不合并瓣膜手术患者死亡率和心肌损伤的影响进行系统回顾和meta分析。方法对RIPC与常规治疗或假RIPC的随机对照试验进行系统评价和meta分析。结果共分析了18项研究,共4551名参与者。曲线下面积显示,RIPC降低了72 h后肌钙蛋白释放(μg·L−1),平均差值(MD)为−3.72 (95% CI为−3.92 ~−3.53,p <0.00001)。然而,当死亡率优势比(OR)为1.27时,RIPC组与对照组之间无显著差异(95% CI 0.87 ~ 1.86, p = 0.22);新发心房颤动的发生率OR 0.82 (95% CI 0.67 ~ 1.01, p = 0.06);肌力支持OR 1.27 (95% CI 0.84 ~ 1.91, p = 0.25);重症监护病房住院天数MD为- 0.02 (95% CI为- 0.12 ~ 0.07,p = 0.61);住院天数MD为0.18 (95% CI为- 0.30 ~ 0.66,p = 0.47),血清肌酐MD为- 0.00 (95% CI为- 0.07 ~ 0.07,p = 0.97)。结论ripc降低对CABG合并或不合并瓣膜手术的患者没有任何临床益处。
Remote ischaemic pre-conditioning does not affect clinical outcomes following coronary Artery bypass grafting. A systematic review and meta-analysis
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.