Remote Ischemic Preconditioning and Clinical Outcomes in On‐Pump Coronary Artery Bypass Grafting: A Meta‐Analysis of 14 Randomized Controlled Trials

Abstract

The purpose of this article is to perform the first pooled analysis on remote ischemic preconditioning (RIPC) used for the improvement of clinical outcomes of patients only undergoing on-pump coronary artery bypass grafting (CABG) in randomized controlled trials (RCTs). A systematic search was performed using PubMed, the Cochrane Library, and the Web of Science to identify studies that described the effect of RIPC on postoperative mortality in patients only undergoing on-pump CABG. The outcomes included postoperative mortality, postoperative morbidity (including incidence of myocardial infarction, atrial fibrillation, stroke, acute kidney injury, and renal replacement therapy), mechanical ventilation (MV), intensive care unit length of stay (ICU LOS), and hospital length of stay (HLOS). A total of 14 RCTs (2830 participants) were included. Our meta-analysis found that RIPC failed to reduce the postoperative mortality in patients only undergoing on-pump CABG compared with control individuals (odds ratio, 0.81; 95% confidence interval, [0.40, 1.64]; P = 0.55; I = 25%). Moreover, there were no differences in postoperative morbidity, ICU LOS, and HLOS between the two groups. However, MV in the RIPC group was shorter than that in control individuals (standard mean difference, -0.41; 95% confidence interval, [-0.80, -0.01]; P = 0.04; I = 73%). The present meta-analysis found that RIPC failed to improve most of clinical outcomes in patients only undergoing on-pump CABG; however, MV was reduced. Adequately powered trials are warranted to provide more evidence in the future.

Remote Ischemic Preconditioning to Prevent Acute Kidney Injury After Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials

“…Some meta-analyses have been previously published evaluating the use of RIPC for preventing AKI after cardiac surgery (32)(33)(34)(35). Compared with these studies, our updated meta-analysis has the following strengths.…”

“…Since most of these studies were of limited sample size, the individual studies may have been statistically insufficient to detect a significant influence of RIPC on postoperative AKI. Furthermore, several previous meta-analyses that pooled studies published through 2016 showed that RIPC was not effective at preventing AKI in patients after on-pump cardiac surgery (32)(33)(34). Although, these results were also inconsistent (35).…”

Multivessel Coronary Revascularization Strategies in Patients with Chronic Kidney Disease: A Meta-Analysis

“…A greater severity of coronary artery lesions and a more traumatic procedure may be related to a higher risk of stroke associated with CABG [49]. Fortunately, some technical procedural improvements and preventive measures can reduce the risk of cerebrovascular accidents, such as CABG and the single-clamp technique, aorta no-touch techniques, measures during cardiopulmonary bypass, prophylactic carotid intervention, utilization of internal mammary artery grafting, prevention of emboli from aortic plaque, intraoperative monitoring, and pharmaceutical therapies [37, 49-51]. However, whether off-pump procedures can reduce the risk of stroke is under debate [40, 52].…”

Efficacy and Safety of Nicorandil in Preventing Contrast-Induced Nephropathy after Elective Percutaneous Coronary Intervention: A Pooled Analysis of 1229 Patients

“…Review Manager 5.3 (Cochrane Collaboration, London, UK) was used for all statistical analyses [ 13 ]. According to the inverse variance method [ 14 ], odds ratio (OR) with 95% confidence interval (CI) for dichotomous outcomes was calculated [ 15 ]. Heterogeneity was measured by I 2 statistic [ 16 ].…”