Response to Letter Regarding Article, “Remote Ischemic Postconditioning During Percutaneous Coronary Interventions: Remote Ischemic Postconditioning-Percutaneous Coronary Intervention Randomized Trial”

Lavi, Ron; D'Alfonso, Sabrina; Diamantouros, Pantelis; Camuglia, A.; Garg, Pallav; Teefy, Patrick; Jablonsky, George; Sridhar, Kumar; Lavi, Shahar

doi:10.1161/circinterventions.114.001591

Cited by 17 publications

(35 citation statements)

References 5 publications

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“…23,24,27,28 However, consistent with our results, it was previously proposed that a beneficial effect of ischemic conditioning is seen only in patients with large infarcts. 29 We allowed elderly patients to be included in the study.…”

Section: Discussionsupporting

confidence: 92%

Sevoflurane in acute myocardial infarction: A pilot randomized study

Lavi

Bainbridge

D'Alfonso

et al. 2014

American Heart Journal

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Section: Discussionsupporting

confidence: 92%

Sevoflurane in acute myocardial infarction: A pilot randomized study

Lavi

Bainbridge

D'Alfonso

et al. 2014

American Heart Journal

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“…Three reports included two intervention groups and one control group, [19][20][21] and one report included two intervention groups and two control groups, 22 resulting in the analysis of 89 trial cohorts. The 89 trial cohorts had a median of 80 participants (interquartile range 60-149) (table 1; supplementary figure A and table D).…”

Section: Trials and Reported Interventionsmentioning

confidence: 99%

Effects of ischaemic conditioning on major clinical outcomes in people undergoing invasive procedures: systematic review and meta-analysis

Sukkar

Hong

Badve

et al. 2016

BMJ

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Objective To summarise the benefits and harms of ischaemic conditioning on major clinical outcomes in various settings.Design Systematic review and meta-analysis.Data sources Medline, Embase, Cochrane databases, and International Clinical Trials Registry platform from inception through October 2015.Study selection All randomised controlled comparisons of the effect of ischaemic conditioning on clinical outcomes were included.Data extraction Two authors independently extracted data from individual reports. Reports of multiple intervention arms were treated as separate trials. Random effects models were used to calculate summary estimates for all cause mortality and other pre-specified clinical outcomes. All cause mortality and secondary outcomes with P<0.1 were examined for study quality by using the GRADE assessment tool, the effect of pre-specified characteristics by using meta-regression and Cochran C test, and trial sequential analysis by using the Copenhagen Trial Unit method.Results 85 reports of 89 randomised comparisons were identified, with a median 80 (interquartile range 60-149) participants and median 1 (range 1 day-72 months) month intended duration. Ischaemic conditioning had no effect on all cause mortality (68 comparisons; 424 events; 11 619 participants; risk ratio 0.96, 95% confidence interval 0.80 to 1.16; P=0.68; moderate quality evidence) regardless of the clinical setting in which it was used or the particular intervention related characteristics. Ischaemic conditioning may reduce the rates of some secondary outcomes including stroke (18 trials; 5995 participants; 149 events; risk ratio 0.72, 0.52 to 1.00; P=0.048; very low quality evidence) and acute kidney injury (36 trials; 8493 participants; 1443 events; risk ratio 0.83, 0.71 to 0.97; P=0.02; low quality evidence), although the benefits seem to be confined to non-surgical settings and to mild episodes of acute kidney injury only.Conclusions Ischaemic conditioning has no overall effect on the risk of death. Possible effects on stroke and acute kidney injury are uncertain given methodological concerns and low event rates. Adoption of ischaemic conditioning cannot be recommended for routine use unless further high quality and well powered evidence shows benefit.

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“…Earlier trials of ischemic postconditioning, typically involving cuff inflation of the upper or lower limbs immediately following PCI, have been inconsistent [106,107]. A recent single center trial randomized 360 patients with stable or unstable angina to remote postconditioning induced by ischemia to the upper or lower limbs ischemia versus no ischemia 25 min after PCI and found no significant difference in the primary outcome of Troponin T post procedure [108]. However, several known observations about conditioning may explain this negative trial, including the fact that the window for cardioprotection may have closed, and that conditioning should have ideally occurred at the time of PCI [109].…”

Section: Ischemic Conditioningmentioning

confidence: 99%