title: Cardiac remote ischaemic preconditioning reduces periprocedural myocardial infarction for patients undergoing percutaneous coronary interventions: a meta-analysis of randomised clinical trials.
abstract: OBJECTIVE
  To establish the cardioprotective effect of remote ischaemic preconditioning (RIPC) in patients undergoing percutaneous coronary intervention (PCI).
  
  
  RESULTS
  Pubmed (MEDLINE), Cochrane and Embase were systematically searched for randomised controlled trials of RIPC in patients undergoing PCI. Periprocedural myocardial infarction (PMI) was the primary endpoint (defined as troponin elevation >3 times upper reference limit) and C-reactive protein (CRP) was a secondary endpoint. Five studies with 731 patients were included. The median age of the patients was 62 (59-68) years old, 25% were female (23-33), 29% (25-33) had diabetes mellitus, and 26.5% (19-31) presented with multivessel disease. RIPC significantly reduced the incidence of PMI (odds ratio: 0.58 [0.36, 0.93]; I2 43%), with a greater benefit when performed using the lower limb (0.21 [0.07-0.66]) compared to the upper limb (0.67 [0.46-0.99]). This reduction was enhanced for patients with multivessel disease (beta -0.05 [-0.09;-0.01], p=0.01) and with type C lesion (beta -0.014 [-0.04;-0.010], p=0.01) and did not vary according to age, female gender, diabetes mellitus, use of beta-blockers and of angiotensin converting enzyme inhibitors. Absolute risk difference was -0.10 [-0.19, -0.02], with a number needed to treat of 10 [6-50] patients to avoid one event. CRP -0.69 [-1.69, 0.31] was not significantly reduced by RIPC.
  
  
  CONCLUSIONS
  RIPC reduced the incidence of PMI following PCI, especially when performed in the lower limb and for patients with multivessel disease and complex lesions.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza, Turin, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Omedè
authors.forename: Enrico
authors.initials: E
authors.lastname: Cerrato
authors.forename: Erika
authors.initials: E
authors.lastname: Cavallero
authors.forename: Fikret
authors.initials: F
authors.lastname: Er
authors.forename: Davide Giacomo
authors.initials: DG
authors.lastname: Presutti
authors.forename: Francesco
authors.initials: F
authors.lastname: Colombo
authors.forename: Gabriele
authors.initials: G
authors.lastname: Crimi
authors.forename: Federico
authors.initials: F
authors.lastname: Conrotto
authors.forename: James J
authors.initials: JJ
authors.lastname: Dinicolantonio
authors.forename: Shaoliang
authors.initials: S
authors.lastname: Chen
authors.forename: Abhiram
authors.initials: A
authors.lastname: Prasad
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi Zoccai
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005121:Extremities / Q000098:blood supply*; D005260:Female; D006801:Humans; D015994:Incidence; D019194:Ischemic Preconditioning / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016896:Treatment Outcome