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Cardioprotective and prognostic effects of remote ischaemic preconditioning in patients undergoing coronary artery bypass surgery: a single-centre randomised, double-blind, controlled trial

Summary Background Remote ischaemic preconditioning has been associated with reduced risk of myocardial injury after coronary artery bypass graft (CABG) surgery. We investigated the safety and efficacy of this procedure. Methods Eligible patients were those scheduled to undergo elective isolated fir... Full description

Journal Title: The Lancet (British edition) 2013, Vol.382 (9892), p.597-604
Main Author: Thielmann, Matthias, MD
Other Authors: Kottenberg, Eva, MD , Kleinbongard, Petra, PhD , Wendt, Daniel, MD , Gedik, Nilgün, MSc , Pasa, Susanne, MD , Price, Vivien , Tsagakis, Konstantinos, MD , Neuhäuser, Markus, Prof , Peters, Jürgen, Prof , Jakob, Heinz, Prof , Heusch, Gerd, Prof
Format: Electronic Article Electronic Article
Language: English
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Quelle: Alma/SFX Local Collection
Publisher: Kidlington: Elsevier Ltd
ID: ISSN: 0140-6736
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title: Cardioprotective and prognostic effects of remote ischaemic preconditioning in patients undergoing coronary artery bypass surgery: a single-centre randomised, double-blind, controlled trial
format: Article
creator:
  • Thielmann, Matthias, MD
  • Kottenberg, Eva, MD
  • Kleinbongard, Petra, PhD
  • Wendt, Daniel, MD
  • Gedik, Nilgün, MSc
  • Pasa, Susanne, MD
  • Price, Vivien
  • Tsagakis, Konstantinos, MD
  • Neuhäuser, Markus, Prof
  • Peters, Jürgen, Prof
  • Jakob, Heinz, Prof
  • Heusch, Gerd, Prof
subjects:
  • Acute coronary syndromes
  • Aged
  • Biological and medical sciences
  • Biomarkers
  • Cardiology. Vascular system
  • Cardiovascular disease
  • Coronary Artery Bypass - methods
  • Coronary Artery Bypass - mortality
  • Coronary Disease - mortality
  • Coronary Disease - surgery
  • Coronary heart disease
  • Coronary vessels
  • Female
  • General aspects
  • Heart
  • Heart attacks
  • Heart surgery
  • Hospitals
  • Humans
  • Internal Medicine
  • Ischemic Preconditioning, Myocardial - adverse effects
  • Ischemic Preconditioning, Myocardial - methods
  • Ischemic Preconditioning, Myocardial - mortality
  • Male
  • Medical sciences
  • Mortality
  • Prognosis
  • Risk Factors
  • Stroke
  • Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
  • Surgery of the heart
  • Time Factors
  • Troponin I - blood
ispartof: The Lancet (British edition), 2013, Vol.382 (9892), p.597-604
description: Summary Background Remote ischaemic preconditioning has been associated with reduced risk of myocardial injury after coronary artery bypass graft (CABG) surgery. We investigated the safety and efficacy of this procedure. Methods Eligible patients were those scheduled to undergo elective isolated first-time CABG surgery under cold crystalloid cardioplegia and cardiopulmonary bypass at the West-German Heart Centre, Essen, Germany, between April, 2008, and October, 2012. Patients were prospectively randomised to receive remote ischaemic preconditioning (three cycles of 5 min ischaemia and 5 min reperfusion in the left upper arm after induction of anaesthesia) or no ischaemic preconditioning (control). The primary endpoint was myocardial injury, as reflected by the geometric mean area under the curve (AUC) for perioperative concentrations of cardiac troponin I (cTnI) in serum in the first 72 h after CABG. Mortality was the main safety endpoint. Analysis was done in intention-to-treat and per-protocol populations. This trial is registered with ClinicalTrials.gov , number NCT01406678. Findings 329 patients were enrolled. Baseline characteristics and perioperative data did not differ between groups. cTnI AUC was 266 ng/mL over 72 h (95% CI 237–298) in the remote ischaemic preconditioning group and 321 ng/mL (287–360) in the control group. In the intention-to-treat population, the ratio of remote ischaemic preconditioning to control for cTnI AUC was 0·83 (95% CI 0·70–0·97, p=0·022). cTnI release remained lower in the per-protocol analysis (0·79, 0·66–0·94, p=0·001). All-cause mortality was assessed over 1·54 (SD 1·22) years and was lower with remote ischaemic preconditioning than without (ratio 0·27, 95% CI 0·08–0·98, p=0·046). Interpretation Remote ischaemic preconditioning provided perioperative myocardial protection and improved the prognosis of patients undergoing elective CABG surgery. Funding German Research Foundation.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0140-6736
fulltext: fulltext
issn:
  • 0140-6736
  • 1474-547X
url: Link


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titleCardioprotective and prognostic effects of remote ischaemic preconditioning in patients undergoing coronary artery bypass surgery: a single-centre randomised, double-blind, controlled trial
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creatorThielmann, Matthias, MD ; Kottenberg, Eva, MD ; Kleinbongard, Petra, PhD ; Wendt, Daniel, MD ; Gedik, Nilgün, MSc ; Pasa, Susanne, MD ; Price, Vivien ; Tsagakis, Konstantinos, MD ; Neuhäuser, Markus, Prof ; Peters, Jürgen, Prof ; Jakob, Heinz, Prof ; Heusch, Gerd, Prof
creatorcontribThielmann, Matthias, MD ; Kottenberg, Eva, MD ; Kleinbongard, Petra, PhD ; Wendt, Daniel, MD ; Gedik, Nilgün, MSc ; Pasa, Susanne, MD ; Price, Vivien ; Tsagakis, Konstantinos, MD ; Neuhäuser, Markus, Prof ; Peters, Jürgen, Prof ; Jakob, Heinz, Prof ; Heusch, Gerd, Prof
descriptionSummary Background Remote ischaemic preconditioning has been associated with reduced risk of myocardial injury after coronary artery bypass graft (CABG) surgery. We investigated the safety and efficacy of this procedure. Methods Eligible patients were those scheduled to undergo elective isolated first-time CABG surgery under cold crystalloid cardioplegia and cardiopulmonary bypass at the West-German Heart Centre, Essen, Germany, between April, 2008, and October, 2012. Patients were prospectively randomised to receive remote ischaemic preconditioning (three cycles of 5 min ischaemia and 5 min reperfusion in the left upper arm after induction of anaesthesia) or no ischaemic preconditioning (control). The primary endpoint was myocardial injury, as reflected by the geometric mean area under the curve (AUC) for perioperative concentrations of cardiac troponin I (cTnI) in serum in the first 72 h after CABG. Mortality was the main safety endpoint. Analysis was done in intention-to-treat and per-protocol populations. This trial is registered with ClinicalTrials.gov , number NCT01406678. Findings 329 patients were enrolled. Baseline characteristics and perioperative data did not differ between groups. cTnI AUC was 266 ng/mL over 72 h (95% CI 237–298) in the remote ischaemic preconditioning group and 321 ng/mL (287–360) in the control group. In the intention-to-treat population, the ratio of remote ischaemic preconditioning to control for cTnI AUC was 0·83 (95% CI 0·70–0·97, p=0·022). cTnI release remained lower in the per-protocol analysis (0·79, 0·66–0·94, p=0·001). All-cause mortality was assessed over 1·54 (SD 1·22) years and was lower with remote ischaemic preconditioning than without (ratio 0·27, 95% CI 0·08–0·98, p=0·046). Interpretation Remote ischaemic preconditioning provided perioperative myocardial protection and improved the prognosis of patients undergoing elective CABG surgery. Funding German Research Foundation.
identifier
0ISSN: 0140-6736
1EISSN: 1474-547X
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languageeng
publisherKidlington: Elsevier Ltd
subjectAcute coronary syndromes ; Aged ; Biological and medical sciences ; Biomarkers ; Cardiology. Vascular system ; Cardiovascular disease ; Coronary Artery Bypass - methods ; Coronary Artery Bypass - mortality ; Coronary Disease - mortality ; Coronary Disease - surgery ; Coronary heart disease ; Coronary vessels ; Female ; General aspects ; Heart ; Heart attacks ; Heart surgery ; Hospitals ; Humans ; Internal Medicine ; Ischemic Preconditioning, Myocardial - adverse effects ; Ischemic Preconditioning, Myocardial - methods ; Ischemic Preconditioning, Myocardial - mortality ; Male ; Medical sciences ; Mortality ; Prognosis ; Risk Factors ; Stroke ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart ; Time Factors ; Troponin I - blood
ispartofThe Lancet (British edition), 2013, Vol.382 (9892), p.597-604
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7Tsagakis, Konstantinos, MD
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9Peters, Jürgen, Prof
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0Cardioprotective and prognostic effects of remote ischaemic preconditioning in patients undergoing coronary artery bypass surgery: a single-centre randomised, double-blind, controlled trial
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descriptionSummary Background Remote ischaemic preconditioning has been associated with reduced risk of myocardial injury after coronary artery bypass graft (CABG) surgery. We investigated the safety and efficacy of this procedure. Methods Eligible patients were those scheduled to undergo elective isolated first-time CABG surgery under cold crystalloid cardioplegia and cardiopulmonary bypass at the West-German Heart Centre, Essen, Germany, between April, 2008, and October, 2012. Patients were prospectively randomised to receive remote ischaemic preconditioning (three cycles of 5 min ischaemia and 5 min reperfusion in the left upper arm after induction of anaesthesia) or no ischaemic preconditioning (control). The primary endpoint was myocardial injury, as reflected by the geometric mean area under the curve (AUC) for perioperative concentrations of cardiac troponin I (cTnI) in serum in the first 72 h after CABG. Mortality was the main safety endpoint. Analysis was done in intention-to-treat and per-protocol populations. This trial is registered with ClinicalTrials.gov , number NCT01406678. Findings 329 patients were enrolled. Baseline characteristics and perioperative data did not differ between groups. cTnI AUC was 266 ng/mL over 72 h (95% CI 237–298) in the remote ischaemic preconditioning group and 321 ng/mL (287–360) in the control group. In the intention-to-treat population, the ratio of remote ischaemic preconditioning to control for cTnI AUC was 0·83 (95% CI 0·70–0·97, p=0·022). cTnI release remained lower in the per-protocol analysis (0·79, 0·66–0·94, p=0·001). All-cause mortality was assessed over 1·54 (SD 1·22) years and was lower with remote ischaemic preconditioning than without (ratio 0·27, 95% CI 0·08–0·98, p=0·046). Interpretation Remote ischaemic preconditioning provided perioperative myocardial protection and improved the prognosis of patients undergoing elective CABG surgery. Funding German Research Foundation.
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2Biological and medical sciences
3Biomarkers
4Cardiology. Vascular system
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6Coronary Artery Bypass - methods
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8Coronary Disease - mortality
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10Coronary heart disease
11Coronary vessels
12Female
13General aspects
14Heart
15Heart attacks
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25Mortality
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29Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
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32Troponin I - blood
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titleCardioprotective and prognostic effects of remote ischaemic preconditioning in patients undergoing coronary artery bypass surgery: a single-centre randomised, double-blind, controlled trial
authorThielmann, Matthias, MD ; Kottenberg, Eva, MD ; Kleinbongard, Petra, PhD ; Wendt, Daniel, MD ; Gedik, Nilgün, MSc ; Pasa, Susanne, MD ; Price, Vivien ; Tsagakis, Konstantinos, MD ; Neuhäuser, Markus, Prof ; Peters, Jürgen, Prof ; Jakob, Heinz, Prof ; Heusch, Gerd, Prof
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7Coronary Artery Bypass - mortality
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abstractSummary Background Remote ischaemic preconditioning has been associated with reduced risk of myocardial injury after coronary artery bypass graft (CABG) surgery. We investigated the safety and efficacy of this procedure. Methods Eligible patients were those scheduled to undergo elective isolated first-time CABG surgery under cold crystalloid cardioplegia and cardiopulmonary bypass at the West-German Heart Centre, Essen, Germany, between April, 2008, and October, 2012. Patients were prospectively randomised to receive remote ischaemic preconditioning (three cycles of 5 min ischaemia and 5 min reperfusion in the left upper arm after induction of anaesthesia) or no ischaemic preconditioning (control). The primary endpoint was myocardial injury, as reflected by the geometric mean area under the curve (AUC) for perioperative concentrations of cardiac troponin I (cTnI) in serum in the first 72 h after CABG. Mortality was the main safety endpoint. Analysis was done in intention-to-treat and per-protocol populations. This trial is registered with ClinicalTrials.gov , number NCT01406678. Findings 329 patients were enrolled. Baseline characteristics and perioperative data did not differ between groups. cTnI AUC was 266 ng/mL over 72 h (95% CI 237–298) in the remote ischaemic preconditioning group and 321 ng/mL (287–360) in the control group. In the intention-to-treat population, the ratio of remote ischaemic preconditioning to control for cTnI AUC was 0·83 (95% CI 0·70–0·97, p=0·022). cTnI release remained lower in the per-protocol analysis (0·79, 0·66–0·94, p=0·001). All-cause mortality was assessed over 1·54 (SD 1·22) years and was lower with remote ischaemic preconditioning than without (ratio 0·27, 95% CI 0·08–0·98, p=0·046). Interpretation Remote ischaemic preconditioning provided perioperative myocardial protection and improved the prognosis of patients undergoing elective CABG surgery. Funding German Research Foundation.
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pubElsevier Ltd
pmid23953384
doi10.1016/S0140-6736(13)61450-6