Remote ischaemic preconditioning for coronary artery bypass grafting (with or without valve surgery)

• Published in: Cochrane database of systematic reviews 2017-05, Vol.5 (5), p.CD011719
• Main Authors: Benstoem, Carina, Stoppe, Christian, Liakopoulos, Oliver J, Ney, Julia, Hasenclever, Dirk, Meybohm, Patrick, Goetzenich, Andreas
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Area Under Curve; B. Stable Ischemic Heart Disease (secondary prevention, treatment, control); Cause of Death; Coronary Artery Bypass; Female; Heart & circulation; Heart Valves - surgery; Humans; Ischemic Preconditioning - adverse effects; Ischemic Preconditioning - methods; Ischemic Preconditioning - mortality; Male; Middle Aged; Myocardial Infarction - epidemiology; Randomized Controlled Trials as Topic; Stroke - epidemiology; Troponin I - metabolism; Troponin T - metabolism
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD011719.pub3

Despite substantial improvements in myocardial preservation strategies, coronary artery bypass grafting (CABG) is still associated with severe complications. It has been reported that remote ischaemic preconditioning (RIPC) reduces reperfusion injury in people undergoing cardiac surgery and improves clinical outcome. However, there is a lack of synthesised information and a need to review the current evidence from randomised controlled trials (RCTs). To assess the benefits and harms of remote ischaemic preconditioning in people undergoing coronary artery bypass grafting, with or without valve surgery. In May 2016 we searched CENTRAL, MEDLINE, Embase and Web of Science. We also conducted a search of ClinicalTrials.gov and the International Clinical Trials Registry Platform (ICTRP). We also checked reference lists of included studies. We did not apply any language restrictions. We included RCTs in which people scheduled for CABG (with or without valve surgery) were randomly assigned to receive RIPC or sham intervention before surgery. Two review authors independently assessed trials for inclusion, extracted data and checked them for accuracy. We calculated mean differences (MDs), standardised mean differences (SMDs) and risk ratios (RR) using a random-effects model. We assessed quality of the trial evidence for all primary outcomes using the GRADE methodology. We completed a 'Risk of bias' assessment for all studies and performed sensitivity analysis by excluding studies judged at high or unclear risk of bias for sequence generation, allocation concealment and incomplete outcome data. We contacted authors for missing data. Our primary endpoints were 1) composite endpoint (including all-cause mortality, non-fatal myocardial infarction or any new stroke, or both) assessed at 30 days after surgery, 2) cardiac troponin T (cTnT, ng/L) at 48 hours and 72 hours, and as area under the curve (AUC) 72 hours (µg/L) after surgery, and 3) cardiac troponin I (cTnI, ng/L) at 48 hours, 72 hours, and as area under the curve (AUC) 72 hours (µg/L) after surgery. We included 29 studies involving 5392 participants (mean age = 64 years, age range 23 to 86 years, 82% male). However, few studies contributed data to meta-analyses due to inconsistency in outcome definition and reporting. In general, risk of bias varied from low to high risk of bias across included studies, and insufficient detail was provided to inform judgement in several cases. The quality of the evidence of key ou