Abstract 16960: Cardiac Remote Ischemic Preconditioning Prior to Elective Vascular Surgery
Introduction: Remote ischemic preconditioning (RIPC) has been shown to reduce infarct size in animal models.
Hypothesis: We hypothesized that RIPC prior to an elective vascular operation would reduce the incidence and amount of a post-operative rise of the cardiac troponin level.
Methods and Results: The Cardiac Remote Ischemic Preconditioning Prior to Elective Vascular Surgery (CRIPES, NCT 01558596) was a prospective, randomized, sham-controlled phase 2 trial using RIPC prior to elective vascular procedures. The RIPC protocol consisted of three cycles of 5-minute forearm ischemia followed by 5-minutes of reperfusion. The primary end-point was the proportion of subjects with a detectable increase in cardiac troponin I (cTnI) and the distribution of such increases. From June 2011 to September 2015, 201 male patients (69 ±7, years) were randomized to either RIPC (n=100) or a sham procedure (n=101). Indications for vascular surgery included an expanding AAA (n=115), occlusive PAD of the lower extremities (n=37) or internal carotid artery stenosis (n=49). Of the 201 patients, 47 (23.5%) had an increase in cTnI above the URL within 72 hours of the vascular operation, with no differences in those patients assigned to RIPC (n=22; 22.2%) versus sham procedure (n=25; 24.7%) (p=0.74). Among the cohort with increased cTnI, the median peak values (interquartile range) in the RIPC and control group were 0.048 (0.004-0.174) and 0.017 (0.003-0.105), respectively (p=0.54).
Conclusions: In this randomized controlled trial of men with increased perioperative cardiac risks, elevation in cardiac troponins was common following vascular surgery but was not reduced by a strategy of RIPC.
Author Disclosures: S. Garcia: None. T. Rector: None. M. Zakharova: None. E.O. McFalls: None.
- © 2016 by American Heart Association, Inc.