期刊
INTERNATIONAL JOURNAL OF CARDIOLOGY
卷 176, 期 1, 页码 20-31出版社
ELSEVIER IRELAND LTD
DOI: 10.1016/j.ijcard.2014.06.018
关键词
Cardioprotection; Cardiovascular surgery; Ischaemic preconditioning; Remote ischaemic preconditioning; Systematic review
资金
- MRC [MC_G1002673] Funding Source: UKRI
- British Heart Foundation [RG/08/015/26411] Funding Source: researchfish
- Medical Research Council [MC_G1002673] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0510-10164, ACF-2010-14-011] Funding Source: researchfish
- Rosetrees Trust [M274] Funding Source: researchfish
Background: A number of 'proof-of-concept' trials suggest that remote ischaemic preconditioning (RIPC) reduces surrogate markers of end-organ injury in patients undergoing major cardiovascular surgery. To date, few studies have involved hard clinical outcomes as primary end-points. Methods: Randomised clinical trials of RIPC in major adult cardiovascular surgery were identified by a systematic review of electronic abstract databases, conference proceedings and article reference lists. Clinical end-points were extracted from trial reports. In addition, trial principal investigators provided unpublished clinical outcome data. Results: In total, 23 trials of RIPC in 2200 patients undergoing major adult cardiovascular surgery were identified. RIPC did not have a significant effect on clinical end-points (death, peri-operative myocardial infarction (MI), renal failure, stroke, mesenteric ischaemia, hospital or critical care length of stay). Conclusion: Pooled data from pilot trials cannot confirm that RIPC has any significant effect on clinically relevant end-points. Heterogeneity in study inclusion and exclusion criteria and in the type of preconditioning stimulus limits the potential for extrapolation at present. An effort must be made to clarify the optimal preconditioning stimulus. Following this, large-scale trials in a range of patient populations are required to ascertain the role of this simple, cost-effective intervention in routine practice. (C) 2014 Elsevier Ireland Ltd. All rights reserved.
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