title: Remote ischaemic preconditioning in coronary artery bypass surgery: a meta-analysis.
abstract: OBJECTIVE
  Randomised trials exploring remote ischaemic preconditioning (RIPC) in patients undergoing coronary artery bypass graft (CABG) surgery have yielded conflicting data regarding potential cardiovascular and renal protection, and are individually flawed by small sample size.
  
  
  METHODS
  Three investigators independently searched the MEDLINE, EMBASE and Cochrane databases to identify randomised trials testing RIPC in patients undergoing CABG.
  
  
  RESULTS
  Nine studies with 704 patients were included. Standardised mean difference of troponin I and T release showed a significant decrease (-0.36 (95% CI -0.62 to -0.09)). This difference held true after excluding the trials with cross-clamp fibrillation, the study with off-pump CABG and studies using a flurane as anaesthetic agent (-0.41 (95% CI -0.69 to -0.12), -0.38 (95% CI -0.70 to -0.07) and -0.37 (95% CI -0.63 to -0.12), respectively). A similar trend was also obtained for patients with multivessel disease (-0.41 (95% CI -0.73 to -0.08)). The trials evaluating postoperative creatinine reported a non-significant reduction (0.02 (95% CI -0.09 to 0.13)). Moreover, the length of in-hospital stay was not influenced by the kind of treatment (weighted mean difference 0.27 (95% CI -0.24 to 0.79)).
  
  
  CONCLUSIONS
  RIPC reduced the release of troponin in patients undergoing CABG. Larger randomised trials are needed to clarify the presence of a causal relationship between RIPC-induced troponin release and clinical adverse events.
authors.affiliation: Division of Cardiology, University of Turin, Turin, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.forename: Erika
authors.initials: E
authors.lastname: Cavallero
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Omedè
authors.forename: Filippo
authors.initials: F
authors.lastname: Sciuto
authors.forename: Ishtiaq A
authors.initials: IA
authors.lastname: Rahman
authors.forename: Robert S
authors.initials: RS
authors.lastname: Bonser
authors.forename: Jeon
authors.initials: J
authors.lastname: Yunseok
authors.forename: Robert
authors.initials: R
authors.lastname: Wagner
authors.forename: Tomas
authors.initials: T
authors.lastname: Freiberger
authors.forename: Gudrun
authors.initials: G
authors.lastname: Kunst
authors.forename: Michael S
authors.initials: MS
authors.lastname: Marber
authors.forename: Matthias
authors.initials: M
authors.lastname: Thielmann
authors.forename: Bingyang
authors.initials: B
authors.lastname: Ji
authors.forename: Yasser M
authors.initials: YM
authors.lastname: Amr
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Modena
authors.forename: Giuseppe Biondi
authors.initials: GB
authors.lastname: Zoccai
authors.forename: Imad
authors.initials: I
authors.lastname: Sheiban
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D015415:Biomarkers / Q000097:blood; D001026:Coronary Artery Bypass / Q000379:methods*; D003404:Creatinine / Q000032:analysis; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial; D007902:Length of Stay; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D019210:Troponin I / Q000097:blood; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D019210:Troponin I; D020107:Troponin T; D003404:Creatinine