Systematic review and meta-analysis of remote ischaemic preconditioning in percutaneous coronary intervention

Abstract

A body of evidence suggests that myocardial infarctions (MI) that are associated with percutaneous coronary intervention (PCI) have prognostic significance but it is uncertain whether remote ischaemic preconditioning (RIPC) offers periprocedural cardioprotection at the time of PCI.Medline, Embase, the Cochrane Central Register of Controlled Trials and conference records were searched (January 1986 to August 2013) for randomised trials that evaluated the effect of RIPC induced by limb ischaemia–reperfusion versus no RIPC in patients who were undergoing PCI. All outcomes were considered for inclusion in the systematic review. Relevant data were extracted and summarised. Pooled odds ratios determined the effect of RIPC compared to control on three prespecified outcomes: troponin positive events in elective PCI, periprocedural MI incidence in elective PCI and acute kidney injury (AKI) incidence in emergency or elective PCI.Eight trials (1119 patients) were found of which six (983 patients) had primary outcomes that were significantly in favour of RIPC. There was no difference in troponin positive events between RIPC and control groups (pooled OR 0.529, 95%CI 0.206–1.358, p=0.185) (three studies, 377 patients). There was a significant reduction in periprocedural MI incidence with RIPC (pooled OR=0.577, 95%CI 0.400–0.833, p=0.003) (four studies, 636 patients). There was no difference in AKI incidence (pooled OR=0.672, 95%CI 0.252–1.787, p=0.425) (two studies, 407 patients).Primary outcomes favoured RIPC in most of the studies. RIPC significantly reduced the incidence of periprocedural MI. Included studies were heterogeneous in methodology and quality.