Effects of pre-procedural remote ischaemic pre-conditioning on the outcomes of elective percutaneous coronary intervention. A systematic review and meta-analysis

Objectives: Trials of remote ischemic pre-conditioning (RIPC) have suggested this intervention reduces complications of percutaneous coronary intervention and coronary by-pass surgery. The aims of this work were to (i) conduct a systematic review and meta-analysis of the effects of RIPC on cardiac and renal damage in patients undertaking elective percutaneous coronary intervention (PCI); (ii) summarize the results in an evidence-based clinical context. Methods: We conducted a systematic search of published randomized controlled trials of RIPC for elective PCI up until May 1st, 2015. Studies of peri- or post-ischemic conditioning or emergency PCI were excluded. Results: Nine studies, totalling 1253 patients were included. Compared to control, RIPC groups exhibited reduced peri-procedural myocardial infarction (MI) Odds Ratio (OR) 0.72 (95% CI 0.54 to 0.97, p = 0.03); ST-segment deviation OR 0.42 (95% CI 0.28 to 0.63, p < 0.0001); major adverse cardiac events (MACE) OR 0.41 (95% CI 0.21 to 0.84, p = 0.01); and acute kidney injury (AKI) OR 0.47 (95% CI 0.26 to 0.86, p = 0.01), but not mortality OR 1.00 (95% CI 0.27 to 3.73, p = 1.00). Conclusions: RIPC is likely to prevent major adverse cardiac and renal events in patients undertaking elective PCI