title: Effect of remote ischaemic preconditioning on clinical outcomes in patients undergoing cardiac bypass surgery: a randomised controlled clinical trial.
abstract: OBJECTIVE
  Remote ischaemic preconditioning (RIPC), using brief cycles of limb ischaemia/reperfusion, is a non-invasive, low-cost intervention that may reduce perioperative myocardial injury (PMI) in patients undergoing cardiac surgery. We investigated whether RIPC can also improve short-term clinical outcomes.
  
  
  METHODS
  One hundred and eighty patients undergoing elective coronary artery bypass graft (CABG) surgery and/or valve surgery were randomised to receive either RIPC (2-5 min cycles of simultaneous upper arm and thigh cuff inflation/deflation; N=90) or control (uninflated cuffs placed on the upper arm and thigh; N=90). The study primary end point was PMI, measured by 72 h area under the curve (AUC) serum high-sensitive troponin-T (hsTnT); secondary end point included short-term clinical outcomes.
  
  
  RESULTS
  RIPC reduced PMI magnitude by 26% (-9.303 difference (CI -15.618 to -2.987) 72 h hsTnT-AUC; p=0.003) compared with control. There was also evidence that RIPC reduced the incidence of postoperative atrial fibrillation by 54% (11% RIPC vs 24% control; p=0.031) and decreased the incidence of acute kidney injury by 48% (10.0% RIPC vs 21.0% control; p=0.063), and intensive care unit stay by 1 day (2.0 days RIPC (CI 1.0 to 4.0) vs 3.0 days control (CI 2.0 to 4.5); p=0.043). In a post hoc analysis, we found that control patients administered intravenous glyceryl trinitrate (GTN) intraoperatively sustained 39% less PMI compared with those not receiving GTN, and RIPC did not appear to reduce PMI in patients given GTN.
  
  
  CONCLUSIONS
  RIPC reduced the extent of PMI in patients undergoing CABG and/or valve surgery. RIPC may also have beneficial effects on short-term clinical outcomes, although this will need to be confirmed in future studies.
  
  
  BACKGROUND
  ClinicalTrials.gov ID: NCT00397163.
authors.affiliation: The Hatter Cardiovascular Institute, University College London, London, UK.
authors.forename: Luciano
authors.initials: L
authors.lastname: Candilio
authors.affiliation: The Hatter Cardiovascular Institute, University College London, London, UK.
authors.forename: Abdul
authors.initials: A
authors.lastname: Malik
authors.affiliation: The Nuffield Trust, London, UK.
authors.forename: Cono
authors.initials: C
authors.lastname: Ariti
authors.affiliation: The Heart Hospital, University College London Hospital, London, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Barnard
authors.affiliation: The Heart Hospital, University College London Hospital, London, UK.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Di Salvo
authors.affiliation: The Heart Hospital, University College London Hospital, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Lawrence
authors.affiliation: The Heart Hospital, University College London Hospital, London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Hayward
authors.affiliation: The Heart Hospital, University College London Hospital, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Yap
authors.affiliation: The Heart Hospital, University College London Hospital, London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Roberts
authors.affiliation: The Heart Hospital, University College London Hospital, London, UK.
authors.forename: Amir
authors.initials: A
authors.lastname: Sheikh
authors.affiliation: The Heart Hospital, University College London Hospital, London, UK.
authors.forename: Shyam
authors.initials: S
authors.lastname: Kolvekar
authors.affiliation: The Hatter Cardiovascular Institute, University College London, London, UK.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Hausenloy
authors.affiliation: The Hatter Cardiovascular Institute, University College London, London, UK.
authors.forename: Derek M
authors.initials: DM
authors.lastname: Yellon
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000097:blood / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods*; D008297:Male; D015428:Myocardial Reperfusion Injury / Q000097:blood / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D019210:Troponin I; D020107:Troponin T
keywords: CARDIAC SURGERY; MYOCARDIAL ISCHAEMIA AND INFARCTION (IHD)