Effects of Remote Ischemic Preconditioning With Postconditioning in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery - Randomized Controlled Trial -

Background: Myocardial injury is associated with an adverse outcome after off-pump coronary artery bypass graft surgery (OPCAB). The authors conducted a randomized controlled trial to evaluate whether remote ischemic preconditioning (RIPC) with remote ischemic postconditioning (RIPostC) reduces myocardial injury in patients undergoing OPCAB. Methods and Results: Seventy patients scheduled for OPCAB were randomly assigned to an RIPC+RIPostC group (n=35) or a control group (n=35). In the RIPC+RIPostC group, 4 cycles of 5-min ischemia and 5-min reperfusion were done on a lower limb before anastomoses (RIPC) and after anastomoses (RIPostC). RIPC+RIPostC significantly reduced postoperative serum troponin I levels (P=0.001). The area under the curve for postoperative troponin I was 48.7% lower in the RIPC+RIPostC group (median [interguartile range], 21.3 h.ng(-1).ml(-1), 16.5-53.1 h.ng(-1).ml(-1) vs. 41.5 h.ng(-1).ml(-1), 24.6-90.2 h.ng(-1).ml(-1), P=0.020). There was no significant difference in creatinine levels and PaO2/FO2 ratios between the 2 groups. Conclusions: RIPC+RIPostC by lower limb ischemia decreased postoperative myocardial enzyme elevation by almost half postoperatively in patients undergoing OPCAB. (Circ J 2012; 76: 884-890)