Abstract 10092: Renal Evidence of Remote Ischemic Conditioning for Elective Coronary Revascularization: A Meta-analysis of 13 Randomized Trials
Background: Several early small trials have concerned about the renal effect of periprocedural remote ischemic conditioning(RIC) in patients with coronary artery disease(CAD), however, negative results were widely obtained. Hence, we sought to summarize the renal evidence of RIC in patients undergoing coronary artery bypass grafting(CABG) or percutaneous coronary intervention(PCI).
Methods: A systematic search was performed in Pubmed, Embase, Cochrane library, and scientific sessions of AHA, ACC and ESC (up to April 2015). Randomized controlled trials with data on postoperative acute kidney injury(AKI) during elective coronary revascularization were included. Odds ratio(OR) with 95% confidence interval(CI) was calculated. Random-effect models were used for the potential clinical inconsistency. Publication bias assessment and sensitivity analysis were performed to evaluate the robustness of the results.
Results: Thirteen RCTs with a total of 1861 CAD patients were identified and selected. Compared with controls, RIC significantly reduced the incidence of AKI (6.61% vs 11.6%;OR= 0.54; 95% CI, 0.37 to 0.78; P=0.001; I2=8.5%; Figure 1). No evidence of significant publication bias were observed (P=0.784, Begg’s test; P=0.096, Egger’s test). Sensitivity analysis of mortality excluding each included study at one time revealed that most individual study was consisted with the direction and size of the overall effect (All P≥0.01).There was no significant difference between CABG subgroup (9.8% vs 16.6%;OR=0.54;95%CI, 0.32 to 0.92; P=0.02; I2=0.0%) and PCI subgroup(5.3% vs 9.4%;OR=0.54; 95% CI, 0.30 to 1.00;P=0.05; I2=36.5%) (P=1.00 for subgroup difference).
Conclusions: Based on the available evidence, RIC provides renal protection by reducing the postprocedural AKI in elective coronary revascularization. Such effect is similar between CABG and PCI.
- remote ischemic conditioning
- acute kidney injury
- coronary artery bypass graft
- percutaneous coronary intervention
Author Disclosures: C. Zhou: None. L. Li: None. Y. Li: None. D. Hausenloy: None. Y. Jeon: None.
- © 2015 by American Heart Association, Inc.