title: Remote ischaemic preconditioning reduces myocardial injury in patients undergoing cardiac surgery with cold-blood cardioplegia: a randomised controlled trial.
abstract: BACKGROUND
  Remote ischaemic preconditioning (RIPC) induced by brief ischaemia and reperfusion of the arm reduces myocardial injury in coronary artery bypass (CABG) surgery patients receiving predominantly cross-clamp fibrillation for myocardial protection. However, cold-blood cardioplegia is the more commonly used method world wide.
  
  
  OBJECTIVE
  To assess whether RIPC is cardioprotective in CABG patients receiving cold-blood cardioplegia.
  
  
  METHODS
  Single-centre, single-blinded, randomised controlled trial.
  
  
  METHODS
  Tertiary referral hospital in London.
  
  
  METHODS
  Adults patients (18-80 years) undergoing elective CABG surgery with or without concomitant aortic valve surgery with cold-blood cardioplegia. Patients with diabetes, renal failure (serum creatinine >130 mmol/l), hepatic or pulmonary disease, unstable angina or myocardial infarction within the past 4 weeks were excluded.
  
  
  METHODS
  Patients were randomised to receive either RIPC (n = 23) or control (n = 22) after anaesthesia. RIPC comprised three 5 min cycles of right forearm ischaemia, induced by inflating a blood pressure cuff on the upper arm to 200 mm Hg, with an intervening 5 min reperfusion. The control group had a deflated cuff placed on the upper arm for 30 min.
  
  
  METHODS
  Serum troponin T was measured preoperatively and at 6, 12, 24, 48 and 72 h after surgery and the area under the curve (AUC at 72 h) calculated.
  
  
  RESULTS
  RIPC reduced absolute serum troponin T release by 42.4% (mean (SD) AUC at 72 h: 31.53 (24.04) microg/l.72 h in controls vs 18.16 (6.67) microg/l.72 h in RIPC; 95% CI 2.4 to 24.3; p = 0.019).
  
  
  CONCLUSIONS
  Remote ischaemic preconditioning induced by brief ischaemia and reperfusion of the arm reduces myocardial injury in CABG surgery patients undergoing cold-blood cardioplegia, making this non-invasive cardioprotective technique widely applicable clinically.
  
  
  BACKGROUND
  NCT00397163.
authors.affiliation: The Hatter Cardiovascular Institute, University College London Hospital, 67 Chenies Mews, London WC1E 6HX, UK.
authors.forename: V
authors.initials: V
authors.lastname: Venugopal
authors.forename: D J
authors.initials: DJ
authors.lastname: Hausenloy
authors.forename: A
authors.initials: A
authors.lastname: Ludman
authors.forename: C
authors.initials: C
authors.lastname: Di Salvo
authors.forename: S
authors.initials: S
authors.lastname: Kolvekar
authors.forename: J
authors.initials: J
authors.lastname: Yap
authors.forename: D
authors.initials: D
authors.lastname: Lawrence
authors.forename: J
authors.initials: J
authors.lastname: Bognolo
authors.forename: D M
authors.initials: DM
authors.lastname: Yellon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods*; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000097:blood / Q000517:prevention & control*; D016037:Single-Blind Method; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood; D055815:Young Adult
chemical_list: D015415:Biomarkers; D020107:Troponin T