Remote ischaemic pre-conditioning does not affect clinical outcomes following coronary Artery bypass grafting: A systematic review and meta-analysis

Background: Trials of remote ischemic pre-conditioning (RIPC) have suggested this intervention reduces complications of angioplasty and coronary artery by-pass grafting (CABG). The aim of this work was to conduct a systematic review and meta-analysis of the effects of RIPC on mortality and myocardial damage in patients undertaking coronary artery bypass grafting with/without valve surgery. Methods: A systematic review and subsequent meta-analysis of randomized controlled trials of RIPC versus usual care or sham RIPC was performed. Results: Eighteen studies, totalling 4551 participants were analysed. RIPC reduced post troponin release as indicated by area under the curve at 72 h (µg.⁻¹) Mean Difference (MD) - 3.72 (95% CI - 3.92 to - 3.53, p < 0.00001). However there was no significant difference between RIPC and control when mortality odds ratio (OR) 1.27 (95% CI 0.87 to 1.86, p = 0.22); the incidence of new onset atrial fibrillation OR 0.82 (95% CI 0.67 to 1.01, p = 0.06); inotropic support OR 1.27 (95% CI 0.84 to 1.91, p = 0.25); intensive care unit stay in days MD - 0.02 (95% CI - 0.12 to 0.07, p = 0.61); Hospital stay in days MD 0.18 (95% CI - 0.30 to 0.66, p = 0.47) and serum creatinine MD - 0.00 (95% CI - 0.07 to 0.07, p = 0.97) were compared. Conclusions: RIPC reduces does not confer any clinical benefit in patients undertaking CABG with/without valve surgery.