| Remote ischaemic preconditioning reduces myocardial injury in patients undergoing cardiac surgery with cold-blood cardioplegia: a randomised controlled trial. | |
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MedLine Citation:
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PMID: 19508973 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Remote ischaemic preconditioning (RIPC) induced by brief ischaemia and reperfusion of the arm reduces myocardial injury in coronary artery bypass (CABG) surgery patients receiving predominantly cross-clamp fibrillation for myocardial protection. However, cold-blood cardioplegia is the more commonly used method world wide. OBJECTIVE: To assess whether RIPC is cardioprotective in CABG patients receiving cold-blood cardioplegia. DESIGN: Single-centre, single-blinded, randomised controlled trial. SETTING: Tertiary referral hospital in London. PATIENTS: Adults patients (18-80 years) undergoing elective CABG surgery with or without concomitant aortic valve surgery with cold-blood cardioplegia. Patients with diabetes, renal failure (serum creatinine >130 mmol/l), hepatic or pulmonary disease, unstable angina or myocardial infarction within the past 4 weeks were excluded. INTERVENTIONS: Patients were randomised to receive either RIPC (n = 23) or control (n = 22) after anaesthesia. RIPC comprised three 5 min cycles of right forearm ischaemia, induced by inflating a blood pressure cuff on the upper arm to 200 mm Hg, with an intervening 5 min reperfusion. The control group had a deflated cuff placed on the upper arm for 30 min. MAIN OUTCOME MEASURES: Serum troponin T was measured preoperatively and at 6, 12, 24, 48 and 72 h after surgery and the area under the curve (AUC at 72 h) calculated. RESULTS: RIPC reduced absolute serum troponin T release by 42.4% (mean (SD) AUC at 72 h: 31.53 (24.04) microg/l.72 h in controls vs 18.16 (6.67) microg/l.72 h in RIPC; 95% CI 2.4 to 24.3; p = 0.019). CONCLUSIONS: Remote ischaemic preconditioning induced by brief ischaemia and reperfusion of the arm reduces myocardial injury in CABG surgery patients undergoing cold-blood cardioplegia, making this non-invasive cardioprotective technique widely applicable clinically. Trial registration number: NCT00397163. |
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Authors:
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V Venugopal; D J Hausenloy; A Ludman; C Di Salvo; S Kolvekar; J Yap; D Lawrence; J Bognolo; D M Yellon |
Publication Detail:
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Type: Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't Date: 2009-06-08 |
Journal Detail:
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Title: Heart (British Cardiac Society) Volume: 95 ISSN: 1468-201X ISO Abbreviation: Heart Publication Date: 2009 Oct |
Date Detail:
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Created Date: 2009-09-15 Completed Date: 2009-10-26 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9602087 Medline TA: Heart Country: England |
Other Details:
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Languages: eng Pagination: 1567-71 Citation Subset: AIM; IM |
Affiliation:
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The Hatter Cardiovascular Institute, University College London Hospital, 67 Chenies Mews, London WC1E 6HX, UK. |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00397163 |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Biological Markers / blood Coronary Artery Bypass / methods* Female Heart Arrest, Induced / methods* Humans Ischemic Preconditioning, Myocardial / methods* Male Middle Aged Myocardial Reperfusion Injury / blood, prevention & control* Single-Blind Method Treatment Outcome Troponin T / blood Young Adult |
| Chemical | |
Reg. No./Substance:
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0/Biological Markers; 0/Troponin T |
| Comments/Corrections | |
Comment In:
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Heart. 2009 Oct;95(19):1553-5
[PMID:
19628467
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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