Alreja Gaurav, Bugano Diogo, Lotfi Amir
Baystate Medical Center, Tufts University School of Medicine, 759 Chestnut Street, Springfield, MA 01089, USA.
J Invasive Cardiol. 2012 Feb;24(2):42-8.
The purpose of this study was to assess the effect of remote ischemic precondition (RIPC) on the incidence of myocardial and renal injury in patients undergoing cardiovascular interventions as measured by biomarkers. Clinical data were pooled to evaluate the usefulness of RIPC to benefit clinical outcomes.
Debate exists regarding the merit of using RIPC for patients undergoing cardiovascular interventions.
Systematic review and meta-analysis of prospective randomized clinical trials of patients undergoing cardiovascular interventions who received RIPC versus control were performed. Two independent reviewers selected articles from MEDLINE, EMBASE, SCOPUS, Cochrane, ISI Web of Science, and BIREME, and through hand search of relevant reviews and meeting abstracts upon agreement. Surrogate markers of myocardial (troponin T or I and CK-MB) and renal (serum creatinine) injury for primary outcomes were abstracted.
Final pooled analysis from 17 clinical trials showed significant heterogeneity of results and no relevant publication bias. Patients receiving RIPC had lower levels of markers of myocardial injury in the first few days after surgery (standardized mean difference [SMD], 0.54; 95% confidence interval [CI], -1.01 to -0.08; P=.01) with highly heterogeneous results (I2 = 93%). A lower incidence of perioperative myocardial infarction (7.9% RIPC vs 13.9% placebo; RR, 0.56; 95% CI, 0.37-0.84; P=.005; I2 = 0%) was also noted. In patients undergoing abdominal aortic aneurysm repair, RIPC when compared to control also decreased renal injury (SMD, 0.28; 95% CI, -0.49 to -0.08; P=.007; I2 = 51%).
RIPC appears to be associated with a favorable effect on serological markers of myocardial and renal injury during cardiovascular interventions. Larger trials should be conducted to substantiate this initial impression.
本研究旨在通过生物标志物评估远程缺血预处理（RIPC）对接受心血管介入治疗患者心肌和肾损伤发生率的影响。汇总临床数据以评估RIPC对改善临床结局的有用性。
对于接受心血管介入治疗的患者使用RIPC的价值存在争议。
对接受RIPC与对照组的心血管介入治疗患者的前瞻性随机临床试验进行系统评价和荟萃分析。两名独立评审员从MEDLINE、EMBASE、SCOPUS、Cochrane、ISI科学网和BIREME中筛选文章，并通过手工检索相关综述和会议摘要进行筛选。提取心肌损伤（肌钙蛋白T或I以及肌酸激酶同工酶MB）和肾损伤（血清肌酐）的替代标志物作为主要结局指标。
17项临床试验的最终汇总分析显示结果存在显著异质性且无相关发表偏倚。接受RIPC的患者术后头几天心肌损伤标志物水平较低（标准化均数差[SMD]，0.54；95%置信区间[CI]，-1.01至-0.08；P = 0.01），结果高度异质性（I² = 93%）。还注意到围手术期心肌梗死发生率较低（RIPC组为7.9%，安慰剂组为13.9%；相对危险度[RR]，0.56；95%CI，0.37 - 0.84；P = 0.005；I² = 0%）。在接受腹主动脉瘤修复的患者中，与对照组相比，RIPC也降低了肾损伤（SMD，0.28；95%CI，-0.49至-0.08；P = 0.007；I² = 51%）。
RIPC似乎与心血管介入治疗期间心肌和肾损伤的血清学标志物的有益作用相关。应进行更大规模的试验以证实这一初步印象。
