Abstract 14034: Prognostic Benefit from Remote Ischemic Preconditioning in 300 Patients Undergoing Coronary Artery Bypass Surgery: A Randomized Controlled Trial
Background: Remote ischemic preconditioning (RIPC) reduced myocardial injury following coronary artery bypass graft (CABG) surgery in recent proof-of-concept and small randomized controlled trials (RCT). We have now investigated not only the short-term effects but also the long-term prognostic significance of RIPC following CABG surgery in a larger single-center RCT (NCT01406678).
Methods and Results: A total of 300 adult patients scheduled for elective isolated first-time CABG surgery under cardiopulmonary bypass and crystalloid cardioplegia were allocated in a prospective, randomized controlled and single-blinded trial to receive either RIPC (n=148; 3 cycles of 5 min transient left upper arm ischemia with 5 min reperfusion after induction of anesthesia) or serve as controls (n=152). Baseline characteristics and intraoperative data did not differ between the two groups. The primary short-term endpoint was myocardial injury following CABG surgery as reflected by the perioperative cardiac troponin I (cTnI) serum concentration over 72 h and its area under the curve (AUC). The mean cTnI concentration in the RIPC group was significantly lower over 72h after surgery (ANOVA; P<0.001), resulting in a 31.7% AUC cTnI reduction vs. controls. The primary long-term endpoint was all-cause mortality, secondary endpoints were major adverse cardiovascular and cerebrovascular events (MACCE: myocardial infarction and stroke) and repeat revascularization during follow-up (follow-up time 483±438 days). There were 6 deaths in controls and 1 in the RIPC group over a maximum follow-up for 4 years. Kaplan-Meier overall survival (P=0.03) and event-free survival (P=0.04) were better in the RIPC group, but MACCE rate (P=0.13) and rate of repeat revascularization (P=0.42) did not differ between the two groups.
Conclusions: O ur RCT not only confirms that RIPC provides myocardial protection but also demonstrates for the first time a prognostic benefit with superior survival for patients undergoing elective CABG surgery with RIPC.
- © 2012 by American Heart Association, Inc.