Remote ischemic preconditioning in elective percutaneous coronary intervention: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

MA Guang , WANG Guoliang , LIU Peng , XUE Yongliang , TENG Wei ,  HUI Xuezhi

Department of Cardiovascular Medicine, the First Affiliated Hospital of Henan University, Kaifeng, 475001, P.R.China;

Corresponding author：

HUI Xuezhi, Email: huixz@163.com

Keywords：

Remote ischemic preconditioning; Elective percutaneous coronary intervention; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.201606068

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To systematically evaluate the clinical value of remote ischemic preconditioning (RIPC) in elective percutaneous coronary intervention (EPCI). Methods We electronically searched databases including PubMed, EMbase, The Cochrane Library (Issue 6, 2015), WanFang Data, CBM and CNKI from inception to June 2016, to collect randomized controlled trials (RCTs) about RIPC in EPCI. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results Nine RCTs involving 1 099 patients were included. The results of meta-analysis showed that: There were no significant difference in the level of troponin I and T between the RIPC group and the control group (SMD=–0.24, 95%CI –0.63 to 0.16,P=0.24). Sensitive analysis showed that with 3×5–min remote preconditioning protocol, there was still no significant difference in the level of troponin I and T between the two groups (SMD=–0.16, 95%CI –0.36 to 0.04,P=0.12). Another, RIPC could significantly reduce the incidence of peri–procedural myocardial infarctions (RD=–0.14, 95%CI –0.20 to –0.08,P<0.000 01) and the risk of ST-segment deviation in the elective PCI procedure (RD=–0.17, 95%CI –0.26 to –0.07,P=0.000 6), but there was no significant difference in postoperative eGFR between both groups (SMD=–0.03, 95%CI –0.18 to 0.12,P=0.71). Conclusion RIPC can significant reduce the incidence of peri-procedural myocardial infarctions, and the risk of ST-segment deviation in the elective PCI procedure. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.

Citation： MA Guang, WANG Guoliang, LIU Peng, XUE Yongliang, TENG Wei, HUI Xuezhi. Remote ischemic preconditioning in elective percutaneous coronary intervention: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2017, 17(1): 87-93. doi: 10.7507/1672-2531.201606068 Copy

1.	Gho BC, Schoemaker RG, van den Doel MA,et al. Myocardial protection by brief ischemia in noncardiac tissue. Circulation, 1996, 94(9): 2193-2200.
2.	Costa JF, Fontes-Carvalho R, Leite-Moreira AF. Myocardial remote ischemic preconditioning: from pathophysiology to clinical application. Rev Port Cardiol, 2013, 32(11): 893-904.
3.	Przyklenk K, Bauer B, Ovize M,et al. Regional ischemic 'preconditioning' protects remote virgin myocardium from subsequent sustained coronary occlusion. Circulation, 1993, 87(3): 893-899.
4.	Anrather J, Hallenbeck JM. Biological networks in ischemic tolerance - rethinking the approach to clinical conditioning. Transl Stroke Res, 2013, 4(1): 114-129.
5.	Hoole SP, Heck PM, Sharples L,et al. Cardiac Remote Ischemic Preconditioning in Coronary Stenting (CRISP Stent) Study: a prospective, randomized control trial. Circulation, 2009, 119(6): 820-827.
6.	Ahmed RM, Mohamed el HA, Ashraf M,et al. Effect of remote ischemic preconditioning on serum troponin T level following elective percutaneous coronary intervention. Catheter Cardiovasc Interv, 2013, 82(5): E647-653.
7.	Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5. 1. 0 [updated March 2011]. The Cochrane Collaboration, 2011. Available at: www. cochrane-handbook. org.
8.	Davies WR, Brown AJ, Watson W,et al. Remote ischemic preconditioning improves outcome at 6 years after elective percutaneous coronary intervention: the CRISP stent trial long-term follow-up. Circ Cardiovasc Interv, 2013, 6(3): 246-251.
9.	Prasad A, Stone GW, Holmes DR,et al. Reperfusion injury, microvascular dysfunction, and cardioprotection: the "dark side" of reperfusion. Circulation, 2009, 120(21): 2105-2112.
10.	Heusch G, Musiolik J, Kottenberg E,et al. STAT5 activation and cardioprotection by remote ischemic preconditioning in humans: short communication. Circ Res, 2012, 110(1): 111-115.
11.	Iliodromitis EK, Kyrzopoulos S, Paraskevaidis IA,et al. Increased C reactive protein and cardiac enzyme levels after coronary stent implantation. Is there protection by remote ischaemic preconditioning? Heart, 2006, 92(12): 1821-1826.
12.	Ghaemian A, Nouraei SM, Abdollahian F,et al. Remote ischemic preconditioning in percutaneous coronary revascularization: a double-blind randomized controlled clinical trial. Asian Cardiovasc Thorac Ann, 2012, 20(5): 548-554.
13.	Luo SJ, Zhou YJ, Shi DM,et al. Remote ischemic preconditioning reduces myocardial injury in patients undergoing coronary stent implantation. Can J Cardiol, 2013, 29(9): 1084-1089.
14.	Zografos TA, Katritsis GD, Tsiafoutis I,et al. Effect of one-cycle remote ischemic preconditioning to reduce myocardial injury during percutaneous coronary intervention. Am J Cardiol, 2014, 113(12): 2013-2017.
15.	Xu X, Zhou Y, Luo S,et al. Effect of remote ischemic preconditioning in the elderly patients with coronary artery disease with diabetes mellitus undergoing elective drug-eluting stent implantation. Angiology, 2014, 65(8): 660-666.
16.	吴万里, 潘朝锌, 吴显儒, 等. 肢体缺血预处理预防经皮冠状动脉介入治疗围术期心肌坏死. 岭南心血管病杂志, 2010, 8(16): 274-277.
17.	周发展, 刘即芳, 尹鲁骅, 等. 远端缺血预处理对经皮冠状动脉介入治疗相关心肌损伤及预后的影响. 中华临床医师杂志, 2014, 8(17): 3068-3072.
18.	Loukogeorgakis SP, Panagiotidou AT, Broadhead MW,et al. Remote ischemic preconditioning provides early and late protection against endothelial ischemia-reperfusion injury in humans: role of the autonomic nervous system. J Am Coll Cardiol, 2005, 46(3): 450-456.
19.	Hong DM, Mint JJ, Kim JH,et al. The effect of remote ischaemic preconditioning on myocardial injury in patients undergoing off-pump coronary artery bypass graft surgery. Anaesth Intensive Care, 2010, 38(5): 924-929.
20.	Vasile VC, Babuin L, Giannitsis E,et al. Relationship of MRI-determined infarct size and cTnI measurements in patients with ST-elevation myocardial infarction. Clin Chem, 2008, 54(3): 617-619.
21.	Jensen RV, Zachara NE, Nielsen PH,et al. Impact of O-GlcNAc on cardioprotection by remote ischaemic preconditioning in non-diabetic and diabetic patients. Cardiovasc Res, 2013, 97(2): 369-378.
22.	Jaffe AS, Apple FS. The third Universal Definition of Myocardial Infarction--moving forward. Clin Chem, 2012, 58(12): 1727-1728.
23.	Er F, Nia AM, Dopp H,et al. Response to letter regarding article, "Ischemic preconditioning for prevention of contrast medium-induced nephropathy: randomized Pilot RenPro-Trial (Renal Protection Trial)". Circulation, 2013, 127(13): e536.

1. Gho BC, Schoemaker RG, van den Doel MA,et al. Myocardial protection by brief ischemia in noncardiac tissue. Circulation, 1996, 94(9): 2193-2200.
2. Costa JF, Fontes-Carvalho R, Leite-Moreira AF. Myocardial remote ischemic preconditioning: from pathophysiology to clinical application. Rev Port Cardiol, 2013, 32(11): 893-904.
3. Przyklenk K, Bauer B, Ovize M,et al. Regional ischemic 'preconditioning' protects remote virgin myocardium from subsequent sustained coronary occlusion. Circulation, 1993, 87(3): 893-899.
4. Anrather J, Hallenbeck JM. Biological networks in ischemic tolerance - rethinking the approach to clinical conditioning. Transl Stroke Res, 2013, 4(1): 114-129.
5. Hoole SP, Heck PM, Sharples L,et al. Cardiac Remote Ischemic Preconditioning in Coronary Stenting (CRISP Stent) Study: a prospective, randomized control trial. Circulation, 2009, 119(6): 820-827.
6. Ahmed RM, Mohamed el HA, Ashraf M,et al. Effect of remote ischemic preconditioning on serum troponin T level following elective percutaneous coronary intervention. Catheter Cardiovasc Interv, 2013, 82(5): E647-653.
7. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5. 1. 0 [updated March 2011]. The Cochrane Collaboration, 2011. Available at: www. cochrane-handbook. org.
8. Davies WR, Brown AJ, Watson W,et al. Remote ischemic preconditioning improves outcome at 6 years after elective percutaneous coronary intervention: the CRISP stent trial long-term follow-up. Circ Cardiovasc Interv, 2013, 6(3): 246-251.
9. Prasad A, Stone GW, Holmes DR,et al. Reperfusion injury, microvascular dysfunction, and cardioprotection: the "dark side" of reperfusion. Circulation, 2009, 120(21): 2105-2112.
10. Heusch G, Musiolik J, Kottenberg E,et al. STAT5 activation and cardioprotection by remote ischemic preconditioning in humans: short communication. Circ Res, 2012, 110(1): 111-115.
11. Iliodromitis EK, Kyrzopoulos S, Paraskevaidis IA,et al. Increased C reactive protein and cardiac enzyme levels after coronary stent implantation. Is there protection by remote ischaemic preconditioning? Heart, 2006, 92(12): 1821-1826.
12. Ghaemian A, Nouraei SM, Abdollahian F,et al. Remote ischemic preconditioning in percutaneous coronary revascularization: a double-blind randomized controlled clinical trial. Asian Cardiovasc Thorac Ann, 2012, 20(5): 548-554.
13. Luo SJ, Zhou YJ, Shi DM,et al. Remote ischemic preconditioning reduces myocardial injury in patients undergoing coronary stent implantation. Can J Cardiol, 2013, 29(9): 1084-1089.
14. Zografos TA, Katritsis GD, Tsiafoutis I,et al. Effect of one-cycle remote ischemic preconditioning to reduce myocardial injury during percutaneous coronary intervention. Am J Cardiol, 2014, 113(12): 2013-2017.
15. Xu X, Zhou Y, Luo S,et al. Effect of remote ischemic preconditioning in the elderly patients with coronary artery disease with diabetes mellitus undergoing elective drug-eluting stent implantation. Angiology, 2014, 65(8): 660-666.
16. 吴万里, 潘朝锌, 吴显儒, 等. 肢体缺血预处理预防经皮冠状动脉介入治疗围术期心肌坏死. 岭南心血管病杂志, 2010, 8(16): 274-277.
17. 周发展, 刘即芳, 尹鲁骅, 等. 远端缺血预处理对经皮冠状动脉介入治疗相关心肌损伤及预后的影响. 中华临床医师杂志, 2014, 8(17): 3068-3072.
18. Loukogeorgakis SP, Panagiotidou AT, Broadhead MW,et al. Remote ischemic preconditioning provides early and late protection against endothelial ischemia-reperfusion injury in humans: role of the autonomic nervous system. J Am Coll Cardiol, 2005, 46(3): 450-456.
19. Hong DM, Mint JJ, Kim JH,et al. The effect of remote ischaemic preconditioning on myocardial injury in patients undergoing off-pump coronary artery bypass graft surgery. Anaesth Intensive Care, 2010, 38(5): 924-929.
20. Vasile VC, Babuin L, Giannitsis E,et al. Relationship of MRI-determined infarct size and cTnI measurements in patients with ST-elevation myocardial infarction. Clin Chem, 2008, 54(3): 617-619.
21. Jensen RV, Zachara NE, Nielsen PH,et al. Impact of O-GlcNAc on cardioprotection by remote ischaemic preconditioning in non-diabetic and diabetic patients. Cardiovasc Res, 2013, 97(2): 369-378.
22. Jaffe AS, Apple FS. The third Universal Definition of Myocardial Infarction--moving forward. Clin Chem, 2012, 58(12): 1727-1728.
23. Er F, Nia AM, Dopp H,et al. Response to letter regarding article, "Ischemic preconditioning for prevention of contrast medium-induced nephropathy: randomized Pilot RenPro-Trial (Renal Protection Trial)". Circulation, 2013, 127(13): e536.

Previous Article
Diagnostic value of miRNAs for pancreatic cancer: a meta-analysis
Next Article
Current evidence of traditional Chinese herb motherwort: a literature review

Chinese Journal of Evidence-Based Medicine

Remote ischemic preconditioning in elective percutaneous coronary intervention: a meta-analysis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content