Cardiac remote ischaemic preconditioning reduces periprocedural myocardial infarction for patients undergoing percutaneous coronary interventions: A meta-analysis of randomised clinical trials

Fabrizio D'Ascenzo, Claudio Moretti, Pierluigi Omedè, Enrico Cerrato, Erika Cavallero, Fikret Er, Davide Giacomo Presutti, Francesco Colombo, Gabriele Crimi, Federico Conrotto, James J. DiNicolantonio, Shaoliang Chen, Abhiram Prasad, Giuseppe Biondi Zoccai, Fiorenzo Gaita

Research output: Contribution to journalArticle

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Abstract

Aims: To establish the cardioprotective effect of remote ischaemic preconditioning (RIPC) in patients under-going percutaneous coronary intervention (PCI). Methods and results: Pubmed (MEDLINE), Cochrane and Embase were systematically searched for ran-domised controlled trials of RIPC in patients undergoing PCI. Periprocedural myocardial infarction (PMI) was the primary endpoint (defined as troponin elevation >3 times upper reference limit) and C-reactive protein (CRP) was a secondary endpoint. Five studies with 731 patients were included. The median age of the patients was 62 (59-68) years old, 25% were female (23-33), 29% (25-33) had diabetes mellitus, and 26.5% (19-31) presented with multivessel disease. RIPC significantly reduced the incidence of PMI (odds ratio: 0.58 [0.36, 0.93]; I2 43%), with a greater benefit when performed using the lower limb (0.21 [0.07-0.66]) compared to the upper limb (0.67 [0.46-0.99]). This reduction was enhanced for patients with multivessel disease (beta -0.05 [-0.09;-0.01], p=0.01) and with type C lesion (beta -0.014 [-0.04;-0.010], p=0.01) and did not vary according to age, female gender, diabetes mellitus, use of beta-blockers and of angiotensin converting enzyme inhibitors. Absolute risk difference was -0.10 [-0.19, -0.02], with a number needed to treat of 10 [6-50] patients to avoid one event. CRP -0.69 [-1.69, 0.31] was not significantly reduced by RIPC. Conclusions: RIPC reduced the incidence of PMI following PCI, especially when performed in the lower limb and for patients with multivessel disease and complex lesions. copyright

Original languageEnglish
Pages (from-to)1463-1471
Number of pages9
JournalEuroIntervention
Volume9
Issue number12
DOIs
Publication statusPublished - 2014

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Ischemic Preconditioning
Percutaneous Coronary Intervention
Meta-Analysis
Randomized Controlled Trials
Myocardial Infarction
C-Reactive Protein
Lower Extremity
Diabetes Mellitus
Numbers Needed To Treat
Troponin
Incidence
Angiotensin-Converting Enzyme Inhibitors
PubMed
Upper Extremity
MEDLINE
Odds Ratio

Keywords

  • Percutaneous coronary intervention
  • Periprocedural myocardial infarction
  • Randomised controlled trials
  • Remote ischaemic preconditioning

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Cardiac remote ischaemic preconditioning reduces periprocedural myocardial infarction for patients undergoing percutaneous coronary interventions : A meta-analysis of randomised clinical trials. / D'Ascenzo, Fabrizio; Moretti, Claudio; Omedè, Pierluigi; Cerrato, Enrico; Cavallero, Erika; Er, Fikret; Presutti, Davide Giacomo; Colombo, Francesco; Crimi, Gabriele; Conrotto, Federico; DiNicolantonio, James J.; Chen, Shaoliang; Prasad, Abhiram; Zoccai, Giuseppe Biondi; Gaita, Fiorenzo.

In: EuroIntervention, Vol. 9, No. 12, 2014, p. 1463-1471.

Research output: Contribution to journalArticle

D'Ascenzo, F, Moretti, C, Omedè, P, Cerrato, E, Cavallero, E, Er, F, Presutti, DG, Colombo, F, Crimi, G, Conrotto, F, DiNicolantonio, JJ, Chen, S, Prasad, A, Zoccai, GB & Gaita, F 2014, 'Cardiac remote ischaemic preconditioning reduces periprocedural myocardial infarction for patients undergoing percutaneous coronary interventions: A meta-analysis of randomised clinical trials', EuroIntervention, vol. 9, no. 12, pp. 1463-1471. https://doi.org/10.4244/EIJV9I12A244
D'Ascenzo, Fabrizio ; Moretti, Claudio ; Omedè, Pierluigi ; Cerrato, Enrico ; Cavallero, Erika ; Er, Fikret ; Presutti, Davide Giacomo ; Colombo, Francesco ; Crimi, Gabriele ; Conrotto, Federico ; DiNicolantonio, James J. ; Chen, Shaoliang ; Prasad, Abhiram ; Zoccai, Giuseppe Biondi ; Gaita, Fiorenzo. / Cardiac remote ischaemic preconditioning reduces periprocedural myocardial infarction for patients undergoing percutaneous coronary interventions : A meta-analysis of randomised clinical trials. In: EuroIntervention. 2014 ; Vol. 9, No. 12. pp. 1463-1471.
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AU - D'Ascenzo, Fabrizio

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AU - Omedè, Pierluigi

AU - Cerrato, Enrico

AU - Cavallero, Erika

AU - Er, Fikret

AU - Presutti, Davide Giacomo

AU - Colombo, Francesco

AU - Crimi, Gabriele

AU - Conrotto, Federico

AU - DiNicolantonio, James J.

AU - Chen, Shaoliang

AU - Prasad, Abhiram

AU - Zoccai, Giuseppe Biondi

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N2 - Aims: To establish the cardioprotective effect of remote ischaemic preconditioning (RIPC) in patients under-going percutaneous coronary intervention (PCI). Methods and results: Pubmed (MEDLINE), Cochrane and Embase were systematically searched for ran-domised controlled trials of RIPC in patients undergoing PCI. Periprocedural myocardial infarction (PMI) was the primary endpoint (defined as troponin elevation >3 times upper reference limit) and C-reactive protein (CRP) was a secondary endpoint. Five studies with 731 patients were included. The median age of the patients was 62 (59-68) years old, 25% were female (23-33), 29% (25-33) had diabetes mellitus, and 26.5% (19-31) presented with multivessel disease. RIPC significantly reduced the incidence of PMI (odds ratio: 0.58 [0.36, 0.93]; I2 43%), with a greater benefit when performed using the lower limb (0.21 [0.07-0.66]) compared to the upper limb (0.67 [0.46-0.99]). This reduction was enhanced for patients with multivessel disease (beta -0.05 [-0.09;-0.01], p=0.01) and with type C lesion (beta -0.014 [-0.04;-0.010], p=0.01) and did not vary according to age, female gender, diabetes mellitus, use of beta-blockers and of angiotensin converting enzyme inhibitors. Absolute risk difference was -0.10 [-0.19, -0.02], with a number needed to treat of 10 [6-50] patients to avoid one event. CRP -0.69 [-1.69, 0.31] was not significantly reduced by RIPC. Conclusions: RIPC reduced the incidence of PMI following PCI, especially when performed in the lower limb and for patients with multivessel disease and complex lesions. copyright

AB - Aims: To establish the cardioprotective effect of remote ischaemic preconditioning (RIPC) in patients under-going percutaneous coronary intervention (PCI). Methods and results: Pubmed (MEDLINE), Cochrane and Embase were systematically searched for ran-domised controlled trials of RIPC in patients undergoing PCI. Periprocedural myocardial infarction (PMI) was the primary endpoint (defined as troponin elevation >3 times upper reference limit) and C-reactive protein (CRP) was a secondary endpoint. Five studies with 731 patients were included. The median age of the patients was 62 (59-68) years old, 25% were female (23-33), 29% (25-33) had diabetes mellitus, and 26.5% (19-31) presented with multivessel disease. RIPC significantly reduced the incidence of PMI (odds ratio: 0.58 [0.36, 0.93]; I2 43%), with a greater benefit when performed using the lower limb (0.21 [0.07-0.66]) compared to the upper limb (0.67 [0.46-0.99]). This reduction was enhanced for patients with multivessel disease (beta -0.05 [-0.09;-0.01], p=0.01) and with type C lesion (beta -0.014 [-0.04;-0.010], p=0.01) and did not vary according to age, female gender, diabetes mellitus, use of beta-blockers and of angiotensin converting enzyme inhibitors. Absolute risk difference was -0.10 [-0.19, -0.02], with a number needed to treat of 10 [6-50] patients to avoid one event. CRP -0.69 [-1.69, 0.31] was not significantly reduced by RIPC. Conclusions: RIPC reduced the incidence of PMI following PCI, especially when performed in the lower limb and for patients with multivessel disease and complex lesions. copyright

KW - Percutaneous coronary intervention

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