title: The effect of remote ischaemic preconditioning on myocardial injury in patients undergoing off-pump coronary artery bypass graft surgery.
abstract: In several recent clinical trials on cardiac surgery patients, remote ischaemic preconditioning (RIPC) showed a powerful myocardial protective effect. However the effect of RIPC has not been studied in patients undergoing off-pump coronary artery bypass graft surgery. We evaluated whether RIPC could induce myocardial protection in off-pump coronary artery bypass graft surgery patients. Patients undergoing elective off-pump coronary artery bypass graft surgery were randomly allocated to the RIPC (n = 65) or control group (n = 65). After induction of anaesthesia, RIPC was induced by four cycles of five-minute ischaemia and reperfusion on the upper limb using a pneumatic cuff. Anaesthesia was maintained with sevoflurane, remifentanil and vecuronium. Myocardial injury was assessed by troponin I before surgery and 1, 6, 12, 24, 48 and 72 hours after surgery. There were no statistical differences in troponin I levels between RIPC and control groups (P = 0.172). Although RIPC reduced the total amount of troponin I (area under the curve of troponin increase) by 26%, it did not reach statistical significance (RIPC group 53.2 +/- 72.9 hours x ng/ml vs control group 67.4 +/- 97.7 hours x ng/ml, P = 0.281). In this study, RIPC by upper limb ischaemia reduced the postoperative myocardial enzyme elevation in off-pump coronary artery bypass graft surgery patients, but this did not reach statistical significance. Further study with a larger number of patients may be needed to fully evaluate the clinical effect of RIPC in off-pump coronary artery bypass graft surgery patients.
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: D M
authors.initials: DM
authors.lastname: Hong
authors.forename: J J
authors.initials: JJ
authors.lastname: Mint
authors.forename: J H
authors.initials: JH
authors.lastname: Kim
authors.forename: I S
authors.initials: IS
authors.lastname: Sohn
authors.forename: T W
authors.initials: TW
authors.lastname: Lim
authors.forename: Y J
authors.initials: YJ
authors.lastname: Lim
authors.forename: J H
authors.initials: JH
authors.lastname: Bahk
authors.forename: Y
authors.initials: Y
authors.lastname: Jeon
mesh_terms: D000368:Aged; D019540:Area Under Curve; D001132:Arm / Q000098:blood supply; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000209:etiology / Q000517:prevention & control*; D010865:Pilot Projects; D013997:Time Factors; D019210:Troponin I / Q000097:blood*
chemical_list: D019210:Troponin I