title: Remote ischemic preconditioning in patients undergoing cardiovascular surgery: Evidence from a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Remote ischemic preconditioning (RIPC) has been associated with reduced risk of myocardial injury in patients undergoing cardiovascular surgery, but uncertainty about clinical outcomes remains, particularly in the light of 2 recent large randomized clinical trials (RCTs) which were neutral. We performed a meta-analysis to evaluate the efficacy of RIPC on clinically relevant outcomes in patients undergoing cardiovascular surgery.
  
  
  METHODS
  We searched PubMed, Cochrane CENTRAL, EMBASE, EBSCO, Web of Science and CINAHL databases from inception through November 30, 2015. RCTs that compared the effects of RIPC vs. control in patients undergoing cardiac and/or vascular surgery were selected. We calculated summary random-effect odds ratios (ORs) and 95% confidence intervals (CI).
  
  
  RESULTS
  The analysis included 5652 patients from 27 RCTs. RIPC reduced the risk of myocardial infarction (MI) (OR 0.72, 95% CI, 0.52 to 1.00; p=0.05; number needed to treat (NNT)=42), acute renal failure (OR 0.73, 95% CI, 0.53 to 1.00; p=0.05; NNT=44) as well as the composite of all cause mortality, MI, stroke or acute renal failure (OR 0.60, 95% CI, 0.39 to 0.90; p=0.01; NNT=25). No significant difference between RIPC and the control groups was observed for the outcome of all-cause mortality (OR 1.10, 95% CI, 0.81 to 1.51). Randomization to RIPC group was also associated with significantly shorter hospital stay (weighted mean difference -0.15days; 95% CI -0.27 to -0.03days).
  
  
  CONCLUSIONS
  RIPC did not decrease overall mortality, but was associated with less MI and acute renal failure and shorter hospitalizations in patients undergoing cardiac or vascular surgery.
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, United States. Electronic address: parthasardarmd@gmail.com.
authors.forename: Partha
authors.initials: P
authors.lastname: Sardar
authors.affiliation: St Luke's-Roosevelt Hospital of the Mount Sinai Health System, New York, NY, United States.
authors.forename: Saurav
authors.initials: S
authors.lastname: Chatterjee
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States.
authors.forename: Amartya
authors.initials: A
authors.lastname: Kundu
authors.affiliation: Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States.
authors.forename: Habib
authors.initials: H
authors.lastname: Samady
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, United States.
authors.forename: Theophilus
authors.initials: T
authors.lastname: Owan
authors.affiliation: Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, United States.
authors.forename: Jay
authors.initials: J
authors.lastname: Giri
authors.affiliation: University of Arkansas for Medical Sciences, Little Rock, AR, United States.
authors.forename: Ramez
authors.initials: R
authors.lastname: Nairooz
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, UT,United States.
authors.forename: Craig H
authors.initials: CH
authors.lastname: Selzman
authors.affiliation: Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Hufelandstr. 55, 45122 Essen, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Heusch
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, MN, United States.
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Gersh
authors.affiliation: Division of Cardiology, Brown Medical School, Rhode Island Hospital, Providence, RI, United States.
authors.forename: J Dawn
authors.initials: JD
authors.lastname: Abbott
authors.affiliation: Texas Tech University Health Sciences Center, El Paso, TX, United States.
authors.forename: Debabrata
authors.initials: D
authors.lastname: Mukherjee
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, United States.
authors.forename: James C
authors.initials: JC
authors.lastname: Fang
mesh_terms: D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods*; D017202:Myocardial Ischemia / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic
keywords: Cardiovascular surgery; Meta-analysis; Remote ischemic preconditioning