The effect of remote ischaemic preconditioning on myocardial injury in patients undergoing off-pump coronary artery bypass graft surgery

• Published in: Anaesthesia and intensive care 2010-09, Vol.38 (5), p.924-929
• Main Authors: HONG, D. M, MIN, J. J, KIM, J. H, SOHN, I. S, LIM, T. W, LIM, Y. J, BAHK, J.-H, JEON, Y
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Area Under Curve; Arm - blood supply; Biological and medical sciences; Coronary Artery Bypass - methods; Female; Humans; Ischemic Preconditioning, Myocardial - methods; Male; Medical sciences; Middle Aged; Myocardial Reperfusion Injury - etiology; Myocardial Reperfusion Injury - prevention & control; Pilot Projects; Time Factors; Troponin I - blood
• ISSN: 0310-057X; 1448-0271
• DOI: 10.1177/0310057x1003800518

In several recent clinical trials on cardiac surgery patients, remote ischaemic preconditioning (RIPC) showed a powerful myocardial protective effect. However the effect of RIPC has not been studied in patients undergoing off-pump coronary artery bypass graft surgery. We evaluated whether RIPC could induce myocardial protection in off-pump coronary artery bypass graft surgery patients. Patients undergoing elective off-pump coronary artery bypass graft surgery were randomly allocated to the RIPC (n = 65) or control group (n = 65). After induction of anaesthesia, RIPC was induced by four cycles of five-minute ischaemia and reperfusion on the upper limb using a pneumatic cuff. Anaesthesia was maintained with sevoflurane, remifentanil and vecuronium. Myocardial injury was assessed by troponin I before surgery and 1, 6, 12, 24, 48 and 72 hours after surgery. There were no statistical differences in troponin I levels between RIPC and control groups (P = 0.172). Although RIPC reduced the total amount of troponin I (area under the curve of troponin increase) by 26%, it did not reach statistical significance (RIPC group 53.2 +/- 72.9 hours x ng/ml vs control group 67.4 +/- 97.7 hours x ng/ml, P = 0.281). In this study, RIPC by upper limb ischaemia reduced the postoperative myocardial enzyme elevation in off-pump coronary artery bypass graft surgery patients, but this did not reach statistical significance. Further study with a larger number of patients may be needed to fully evaluate the clinical effect of RIPC in off-pump coronary artery bypass graft surgery patients.