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Effect of remote ischemic preconditioning on myocardial and renal injury: meta-analysis of randomized controlled trials.
MedLine Citation:
PMID:  22294530     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
OBJECTIVES: The purpose of this study was to assess the effect of remote ischemic precondition (RIPC) on the incidence of myocardial and renal injury in patients undergoing cardiovascular interventions as measured by biomarkers. Clinical data were pooled to evaluate the usefulness of RIPC to benefit clinical outcomes.
BACKGROUND: Debate exists regarding the merit of using RIPC for patients undergoing cardiovascular interventions.
METHODS: Systematic review and meta-analysis of prospective randomized clinical trials of patients undergoing cardiovascular interventions who received RIPC versus control were performed. Two independent reviewers selected articles from MEDLINE, EMBASE, SCOPUS, Cochrane, ISI Web of Science, and BIREME, and through hand search of relevant reviews and meeting abstracts upon agreement. Surrogate markers of myocardial (troponin T or I and CK-MB) and renal (serum creatinine) injury for primary outcomes were abstracted.
RESULTS: Final pooled analysis from 17 clinical trials showed significant heterogeneity of results and no relevant publication bias. Patients receiving RIPC had lower levels of markers of myocardial injury in the first few days after surgery (standardized mean difference [SMD], 0.54; 95% confidence interval [CI], -1.01 to -0.08; P=.01) with highly heterogeneous results (I2 = 93%). A lower incidence of perioperative myocardial infarction (7.9% RIPC vs 13.9% placebo; RR, 0.56; 95% CI, 0.37-0.84; P=.005; I2 = 0%) was also noted. In patients undergoing abdominal aortic aneurysm repair, RIPC when compared to control also decreased renal injury (SMD, 0.28; 95% CI, -0.49 to -0.08; P=.007; I2 = 51%).
CONCLUSIONS: RIPC appears to be associated with a favorable effect on serological markers of myocardial and renal injury during cardiovascular interventions. Larger trials should be conducted to substantiate this initial impression.
Authors:
Gaurav Alreja; Diogo Bugano; Amir Lotfi
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of invasive cardiology     Volume:  24     ISSN:  1557-2501     ISO Abbreviation:  J Invasive Cardiol     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-02-01     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8917477     Medline TA:  J Invasive Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  42-8     Citation Subset:  IM    
Affiliation:
Baystate Medical Center, Tufts University School of Medicine, Internal Medicine, 759 Chestnut Street, Springfield, MA 01089 USA. galreja@yahoo.com.
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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