Youn Joung Cho1, Eun-Ho Lee2, Kanghee Lee1, Tae Kyong Kim1, Deok Man Hong1, Ji-Hyun Chin2, Dae-Kee Choi2, Jae-Hyon Bahk1, Ji-Yeon Sim2, In-Cheol Choi2, Yunseok Jeon3. 1. Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea. 2. Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. 3. Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: jeonyunseok@gmail.com.
Abstract
BACKGROUND: Remote ischemic conditioning has been shown to confer myocardial protection. However, there is still no sufficient data on its long-term clinical outcomes. We analyzed the long-term results of the Remote Ischemic Preconditioning and Postconditioning Outcome (RISPO) trial in cardiac surgery patients. METHODS: In the RISPO trial, 1280 patients were randomized to receive remote ischemic preconditioning (RIPC) with postconditioning (RIPostC, upper arm ischemia by four cycles of 5-min inflation followed by 5-min deflation of a pneumatic cuff, N=644) or sham (N=636) during cardiac surgery. Patient follow-up data were collected by review of medical records, telephone interviews, and from the National Statistical Office. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE; a composite of all-cause mortality, myocardial infarction (MI), stroke, and revascularization), and the secondary endpoints were the individual components of the primary endpoint. RESULTS: At completion of follow-up (mean 44months), there was no difference in MACCE between the groups (90 [14.0%] versus 101 [15.9%] in the RIPC with RIPostC versus control groups; hazard ratio [HR], 0.893; 95% confidence interval [CI], 0.672-1.187; P=0.435). However, MI was reduced to half in the RIPC with RIPostC group (10 [1.6%] versus 23 [3.6%]; HR, 0.468; 95% CI, 0.222-0.984; P=0.045). CONCLUSIONS: Remote ischemic preconditioning with RIPostC did not improve long-term MACCE after cardiac surgery. However, MI was reduced in the RIPC with RIPostC group compared with the control group during the follow-up period. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT00997217.
RCT Entities:
BACKGROUND: Remote ischemic conditioning has been shown to confer myocardial protection. However, there is still no sufficient data on its long-term clinical outcomes. We analyzed the long-term results of the Remote Ischemic Preconditioning and Postconditioning Outcome (RISPO) trial in cardiac surgery patients. METHODS: In the RISPO trial, 1280 patients were randomized to receive remote ischemic preconditioning (RIPC) with postconditioning (RIPostC, upper arm ischemia by four cycles of 5-min inflation followed by 5-min deflation of a pneumatic cuff, N=644) or sham (N=636) during cardiac surgery. Patient follow-up data were collected by review of medical records, telephone interviews, and from the National Statistical Office. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE; a composite of all-cause mortality, myocardial infarction (MI), stroke, and revascularization), and the secondary endpoints were the individual components of the primary endpoint. RESULTS: At completion of follow-up (mean 44months), there was no difference in MACCE between the groups (90 [14.0%] versus 101 [15.9%] in the RIPC with RIPostC versus control groups; hazard ratio [HR], 0.893; 95% confidence interval [CI], 0.672-1.187; P=0.435). However, MI was reduced to half in the RIPC with RIPostC group (10 [1.6%] versus 23 [3.6%]; HR, 0.468; 95% CI, 0.222-0.984; P=0.045). CONCLUSIONS: Remote ischemic preconditioning with RIPostC did not improve long-term MACCE after cardiac surgery. However, MI was reduced in the RIPC with RIPostC group compared with the control group during the follow-up period. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT00997217.
Authors: Xiaoping Ren; Anne E Roessler; Thomas L Lynch; Lauren Haar; Faryal Mallick; Yong Lui; Michael Tranter; Michelle Huan Ren; Wen Rui Xie; Guo-Chang Fan; Jun-Ming Zhang; Evangelia G Kranias; Ahmad Anjak; Sheryl Koch; Min Jiang; Qing Miao; Yang Wang; Albert Cohen; Jack Rubinstein; Neal L Weintraub; W Keith Jones Journal: Am J Physiol Heart Circ Physiol Date: 2018-12-21 Impact factor: 5.125