ISSN 2996-8215
International Journal of Cardiology | Vol. 2, No. 6, June 2011 | pp. 41–48
DOI: 10.46882/2011/IJC/000027
Original Research Article
Cardioprotective Effects of Remote Ischemic Preconditioning in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting
Vasily Smirnov¹, Dmitry Ivanov¹, Elena Kuzmina²
¹Department of Cardiac Surgery, Almazov National Medical Research Centre, St. Petersburg, Russia
²Institute of Cardiovascular Diseases, Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
Abstract:
Myocardial injury during coronary artery bypass grafting (CABG) affects long-term surgical success. Remote ischemic preconditioning (RIPC)—induced by transient cycles of ischemia and reperfusion in a limb—represents a simple, non-invasive method to protect the myocardium. This randomized sham-controlled trial evaluated the cardioprotective efficacy of RIPC in patients undergoing off-pump CABG. We randomized 160 patients scheduled for elective off-pump CABG to either the RIPC group (n = 80) or the sham control group (n = 80). RIPC was performed immediately after anesthesia induction by inflating a standard blood pressure cuff on the upper arm to 200 mmHg for 5 minutes, followed by 5 minutes of reperfusion, for a total of 3 cycles. Myocardial injury was assessed by measuring serum cardiac troponin I (cTnI) and creatine kinase-MB (CK-MB) levels at baseline, and 6, 12, 24, and 48 hours postoperatively. The total postoperative release of cTnI, assessed by the area under the curve (AUC) over 48 hours, was reduced by 26% in the RIPC group compared to the sham group (mean AUC: 42.4 ± 11.5 ng/mL/h vs. 57.3 ± 14.2 ng/mL/h, p < 0.01). Postoperative CK-MB levels were also significantly lower in the RIPC cohort at 12 and 24 hours (p < 0.05). There were no protocol-related vascular or neurological complications in the upper extremity. Remote ischemic preconditioning significantly attenuates perioperative myocardial injury in patients undergoing off-pump coronary artery bypass surgery, demonstrating safe, easily applicable cardioprotection.
Keywords: Remote ischemic preconditioning, Myocardial injury, Coronary artery bypass grafting, Off-pump surgery, Cardiac troponin I
Received: March 15, 2011; Revised: April 22, 2011; Accepted: May 10, 2011; Published: June 18, 2011
Citation: International Journal of Cardiology, 2011, Vol. 2, No. 6, pp. 41–48, DOI: 10.46882/2011/IJC/000027
International Journal of Cardiology | Vol. 2, No. 7, July 2011 | pp. 49–56
DOI: 10.46882/2011/IJC/000028
Original Researc