Cardiac Remote Ischemic Preconditioning Prior to Elective Vascular Surgery (CRIPES): A Prospective, Randomized, Sham-Controlled Phase II Clinical Trial.
Remote ischemic preconditioning (RIPC) has been shown to reduce infarct size in animal models. We hypothesized that RIPC before an elective vascular operation would reduce the incidence and amount of a postoperative rise of the cardiac troponin level.



Cardiac Remote Ischemic Preconditioning Prior to Elective Vascular Surgery (CRIPES) was a prospective, randomized, sham-controlled phase 2 trial using RIPC before elective vascular procedures. The RIPC protocol consisted of 3 cycles of 5-minute forearm ischemia followed by 5 minutes of reperfusion. The primary endpoint was the proportion of subjects with a detectable increase in cardiac troponin I (cTnI) and the distribution of such increases. From June 2011 to September 2015, 201 male patients (69±7, years) were randomized to either RIPC (n=100) or a sham procedure (n=101). Indications for vascular surgery included an expanding abdominal aortic aneurysm (n=115), occlusive peripheral arterial disease of the lower extremities (n=37), or internal carotid artery stenosis (n=49). Of the 201 patients, 47 (23.5%) had an increase in cTnI above the upper reference limit within 72 hours of the vascular operation, with no statistically significant difference between those patients assigned to RIPC (n=22; 22.2%) versus sham procedure (n=25; 24.7%; P=0.67). Among the cohort with increased cTnI, the median peak values (interquartile range) in the RIPC and control group were 0.048 (0.004-0.174) and 0.017 (0.003-0.105), respectively (P=0.54).



In this randomized, controlled trial of men with increased perioperative cardiac risks, elevation in cardiac troponins was common following vascular surgery, but was not reduced by a strategy of RIPC.



URL: https://www.clinicaltrials.gov. Unique identifier: NCT01558596.
Division of Cardiology, Department of Internal Medicine, Minneapolis VA Healthcare System, Minneapolis, MN Division of Cardiology, University of Minnesota, Minneapolis, MN garci205@umn.edu.
Santiago
S
Garcia
Division of Cardiology, Department of Internal Medicine, Minneapolis VA Healthcare System, Minneapolis, MN.
Thomas S
TS
Rector
Division of Cardiology, University of Minnesota, Minneapolis, MN.
Marina
M
Zakharova
Division of Cardiology, Department of Internal Medicine, Minneapolis VA Healthcare System, Minneapolis, MN.
Rebekah R
RR
Herrmann
Division of Cardiology, Department of Internal Medicine, Minneapolis VA Healthcare System, Minneapolis, MN Division of Cardiology, University of Minnesota, Minneapolis, MN.
Selcuk
S
Adabag
Division of Cardiology, Department of Internal Medicine, Minneapolis VA Healthcare System, Minneapolis, MN Division of Cardiology, University of Minnesota, Minneapolis, MN.
Stefan
S
Bertog
Hennepin County Medical Center, Minneapolis, MN Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN.
Yader
Y
Sandoval
Division of Vascular Surgery, Minneapolis VA Healthcare System, Minneapolis, MN.
Steve
S
Santilli
VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX.
Emmanouil S
ES
Brilakis
Division of Cardiology, Department of Internal Medicine, Minneapolis VA Healthcare System, Minneapolis, MN Division of Cardiology, University of Minnesota, Minneapolis, MN.
Edward O
EO
McFalls
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D016893:Carotid Stenosis / Q000601:surgery*; D017558:Elective Surgical Procedures; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods*; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000517:prevention & control*; D058729:Peripheral Arterial Disease / Q000601:surgery*; D011183:Postoperative Complications / Q000097:blood / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood; D014656:Vascular Surgical Procedures / Q000379:methods*
D019210:Troponin I
remote preconditioning; troponins; vascular surgery
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