There is a need of cardiac protective strategies for high risk patients undergoing cardiac surgery. Remote ischemic conditioning (RIC) supposes a simple non-invasive and low-cost intervention that may improve long-term clinical outcomes in this setting.
Material and methods
1612 patients from 29 UK centers undergoing on-pump CABG with or without valve surgery, with Euroscore ≥ 5 were randomized to RIC consisting of 4x 5 min BP cuff inflations / deflations versus a sham procedure. Primary outcome was the composite of one year cardiovascular death, myocardial infarction, Stroke, or need of revascularization. Secondary endpoints were peri-operative myocardial injury, inotrope score, acute Kidney Injury, and length of ITU/ Hospital stay.
There were not important baseline characteristic differences between both groups. Average EuroSCORE was 6.6 and 6.7 in RIC and control arm respectively. Approximately half of patients underwent CABG with valve surgery associated in both arms. Average cardiopulmonary bypass time was 112 min in both arms. Primary endpoint occurred at one year in 27% and 28% of patients in RIC and control arm respectively (HR 0.96; 95% CI 0.8-1.16; p=0.66). There were not statistical significant differences between groups in the components or primary endpoint. Peri-operative myocardial injury assessed by 72 hours AUC Trop-T in ng.h/ml was 30.1 in RIC arm and 35.7 in control arm (p=0.031).
RIC did not improve long-term clinical outcomes in high-risk patients undergoing on-pump cardiac bypass surgery with blood cardioplegia.