Remote preconditioning and major clinical complications following adult cardiovascular surgery: systematic review and meta-analysis
Jazyk angličtina Země Nizozemsko Médium print-electronic
Typ dokumentu časopisecké články, metaanalýza, přehledy, systematický přehled
Grantová podpora
MC_G1002673
Medical Research Council - United Kingdom
RG/08/015/26411
British Heart Foundation - United Kingdom
PubMed
25022819
DOI
10.1016/j.ijcard.2014.06.018
PII: S0167-5273(14)01085-7
Knihovny.cz E-zdroje
- Klíčová slova
- Cardioprotection, Cardiovascular surgery, Ischaemic preconditioning, Remote ischaemic preconditioning, Systematic review,
- MeSH
- dospělí MeSH
- elektronické zdravotní záznamy * MeSH
- ischemické přivykání metody MeSH
- kardiochirurgické výkony škodlivé účinky MeSH
- kardiovaskulární nemoci diagnóza chirurgie MeSH
- lidé MeSH
- pooperační komplikace * diagnóza etiologie MeSH
- randomizované kontrolované studie jako téma metody MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- přehledy MeSH
- systematický přehled MeSH
BACKGROUND: A number of 'proof-of-concept' trials suggest that remote ischaemic preconditioning (RIPC) reduces surrogate markers of end-organ injury in patients undergoing major cardiovascular surgery. To date, few studies have involved hard clinical outcomes as primary end-points. METHODS: Randomised clinical trials of RIPC in major adult cardiovascular surgery were identified by a systematic review of electronic abstract databases, conference proceedings and article reference lists. Clinical end-points were extracted from trial reports. In addition, trial principal investigators provided unpublished clinical outcome data. RESULTS: In total, 23 trials of RIPC in 2200 patients undergoing major adult cardiovascular surgery were identified. RIPC did not have a significant effect on clinical end-points (death, peri-operative myocardial infarction (MI), renal failure, stroke, mesenteric ischaemia, hospital or critical care length of stay). CONCLUSION: Pooled data from pilot trials cannot confirm that RIPC has any significant effect on clinically relevant end-points. Heterogeneity in study inclusion and exclusion criteria and in the type of preconditioning stimulus limits the potential for extrapolation at present. An effort must be made to clarify the optimal preconditioning stimulus. Following this, large-scale trials in a range of patient populations are required to ascertain the role of this simple, cost-effective intervention in routine practice.
Addenbrooke's Hospital Cambridge United Kingdom
Central South University Hunan China
Changi General Hospital Singapore
Hatter Cardiovascular Institute University College London United Kingdom
Maine Medical Centre ME United States
National University of Ireland Galway Ireland
Novosibirsk State Research Institute of Circulation Pathology Novosibirsk Russia
Queen Elizabeth Medical Centre Birmingham United Kingdom
Seoul National University Hospital Seoul South Korea
St Anne's University Hospital Brno Czech Republic
University Hospital Essen Essen Germany
University Hospital Frankfurt Germany
University Hospital Frankfurt Germany; University Hospital Schleswig Holstein Kiel Germany
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