TY - JOUR
T1 - Cardiac remote ischaemic preconditioning reduces periprocedural myocardial infarction for patients undergoing percutaneous coronary interventions
T2 - A meta-analysis of randomised clinical trials
AU - D'Ascenzo, Fabrizio
AU - Moretti, Claudio
AU - Omedè, Pierluigi
AU - Cerrato, Enrico
AU - Cavallero, Erika
AU - Er, Fikret
AU - Presutti, Davide Giacomo
AU - Colombo, Francesco
AU - Crimi, Gabriele
AU - Conrotto, Federico
AU - DiNicolantonio, James J.
AU - Chen, Shaoliang
AU - Prasad, Abhiram
AU - Zoccai, Giuseppe Biondi
AU - Gaita, Fiorenzo
PY - 2014/4
Y1 - 2014/4
N2 - Aims: To establish the cardioprotective effect of remote ischaemic preconditioning (RIPC) in patients under-going percutaneous coronary intervention (PCI). Methods and results: Pubmed (MEDLINE), Cochrane and Embase were systematically searched for ran-domised controlled trials of RIPC in patients undergoing PCI. Periprocedural myocardial infarction (PMI) was the primary endpoint (defined as troponin elevation >3 times upper reference limit) and C-reactive protein (CRP) was a secondary endpoint. Five studies with 731 patients were included. The median age of the patients was 62 (59-68) years old, 25% were female (23-33), 29% (25-33) had diabetes mellitus, and 26.5% (19-31) presented with multivessel disease. RIPC significantly reduced the incidence of PMI (odds ratio: 0.58 [0.36, 0.93]; I2 43%), with a greater benefit when performed using the lower limb (0.21 [0.07-0.66]) compared to the upper limb (0.67 [0.46-0.99]). This reduction was enhanced for patients with multivessel disease (beta -0.05 [-0.09;-0.01], p=0.01) and with type C lesion (beta -0.014 [-0.04;-0.010], p=0.01) and did not vary according to age, female gender, diabetes mellitus, use of beta-blockers and of angiotensin converting enzyme inhibitors. Absolute risk difference was -0.10 [-0.19, -0.02], with a number needed to treat of 10 [6-50] patients to avoid one event. CRP -0.69 [-1.69, 0.31] was not significantly reduced by RIPC. Conclusions: RIPC reduced the incidence of PMI following PCI, especially when performed in the lower limb and for patients with multivessel disease and complex lesions. copyright
AB - Aims: To establish the cardioprotective effect of remote ischaemic preconditioning (RIPC) in patients under-going percutaneous coronary intervention (PCI). Methods and results: Pubmed (MEDLINE), Cochrane and Embase were systematically searched for ran-domised controlled trials of RIPC in patients undergoing PCI. Periprocedural myocardial infarction (PMI) was the primary endpoint (defined as troponin elevation >3 times upper reference limit) and C-reactive protein (CRP) was a secondary endpoint. Five studies with 731 patients were included. The median age of the patients was 62 (59-68) years old, 25% were female (23-33), 29% (25-33) had diabetes mellitus, and 26.5% (19-31) presented with multivessel disease. RIPC significantly reduced the incidence of PMI (odds ratio: 0.58 [0.36, 0.93]; I2 43%), with a greater benefit when performed using the lower limb (0.21 [0.07-0.66]) compared to the upper limb (0.67 [0.46-0.99]). This reduction was enhanced for patients with multivessel disease (beta -0.05 [-0.09;-0.01], p=0.01) and with type C lesion (beta -0.014 [-0.04;-0.010], p=0.01) and did not vary according to age, female gender, diabetes mellitus, use of beta-blockers and of angiotensin converting enzyme inhibitors. Absolute risk difference was -0.10 [-0.19, -0.02], with a number needed to treat of 10 [6-50] patients to avoid one event. CRP -0.69 [-1.69, 0.31] was not significantly reduced by RIPC. Conclusions: RIPC reduced the incidence of PMI following PCI, especially when performed in the lower limb and for patients with multivessel disease and complex lesions. copyright
KW - Percutaneous coronary intervention
KW - Periprocedural myocardial infarction
KW - Randomised controlled trials
KW - Remote ischaemic preconditioning
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U2 - 10.4244/EIJV9I12A244
DO - 10.4244/EIJV9I12A244
M3 - Review article
C2 - 24755386
AN - SCOPUS:84902363559
SN - 1774-024X
VL - 9
SP - 1463
EP - 1471
JO - EuroIntervention
JF - EuroIntervention
IS - 12
ER -