ISSN 2996-8215
International Journal of Cardiology | Vol. 15, No. 6, June 2024 | pp. 41–48
DOI: 10.46882/2024/IJC/000182
Original Research Article
Cardioprotective Efficacy of Remote Ischemic Preconditioning in Patients with Multivessel Coronary Disease Undergoing Off-Pump CABG
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 outcomes and reverse structural remodeling. Remote ischemic preconditioning (RIPC)—induced by brief transient cycles of ischemia and reperfusion in a limb—represents a non-invasive strategy to protect target myocardium. This randomized sham-controlled clinical trial evaluated the cardioprotective efficacy of RIPC in patients with multivessel coronary disease undergoing off-pump CABG. We randomized 180 patients scheduled for elective off-pump CABG to either the RIPC group (n = 90) or the sham control group (n = 90). RIPC was induced 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 complete cycles. Perioperative myocardial injury was quantified 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 cumulative postoperative release of cTnI, assessed by the 48-hour area under the curve (AUC), was significantly reduced by 24% in the RIPC group compared to the sham group (mean AUC: 44.2 ± 11.2 ng/mL/h vs. 58.4 ± 14.5 ng/mL/h, p < 0.01). Total post-procedural CK-MB release was also significantly lower in the RIPC cohort at 12 and 24 hours (p < 0.05). No protocol-related vascular complications occurred. Remote ischemic preconditioning significantly limits perioperative myocardial injury in patients undergoing off-pump coronary artery bypass surgery, offering safe and easily applicable cardioprotection.
Keywords: Remote ischemic preconditioning, Myocardial injury, Coronary artery bypass grafting, Off-pump surgery, Cardiac troponin I, Cardioprotection
Received: March 11, 2024; Revised: April 22, 2024; Accepted: May 12, 2024; Published: June 18, 2024