Wang Xiangming, Kong Na, Zhou Chuanwei, Mungun Deeraj, Iyan Zakaria, Guo Yan, Yang Zhijian
Department of Geriatric Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Reproductive Medicine Center, The Affiliated Drum Tower Hospital of Nanjing University, Nanjing, China.
Cardiol Res Pract. 2017;2017:6907167. doi: 10.1155/2017/6907167. Epub 2017 Sep 14.
The main objective of this meta-analysis was to investigate whether remote ischemic preconditioning (RIPC) reduces cardiac and renal events in patients undergoing elective cardiovascular interventions.
We systematically searched articles published from 2006 to 2016 in PubMed, EMBASE, Web of Science, Cochrane Library, and Google Scholar. Odds ratios (ORs) with 95% confidence intervals (CIs) were used as the effect index for dichotomous variables. The standardized mean differences (SMDs) with 95% CIs were calculated as the pooled continuous effect. Sixteen RCTs of 2435 patients undergoing elective PCI were selected. Compared with control group, RIPC could significantly reduce the incidence of perioperative myocardial infarction (OR = 0.64; 95% CI: 0.48-0.86; = 0.003) and acute kidney injury (OR = 0.56; 95% CI: 0.322-0.99; = 0.049). Metaregression analysis showed that the reduction of PMI by RIPC was enhanced for CAD patients with multivessel disease (coef.: -0.05 [-0.09; -0.01], = 0.022). There were no differences in the changes of cTnI ( = 0.934) and CRP ( = 0.075) in two groups.
Our meta-analysis of RCTs demonstrated that RIPC can provide cardiac and renal protection for patients undergoing elective PCI, while no beneficial effect on reducing the levels of cTnI and CRP after PCI was reported.
本荟萃分析的主要目的是研究远程缺血预处理（RIPC）是否能减少接受择期心血管介入治疗患者的心脏和肾脏事件。
我们系统检索了2006年至2016年发表在PubMed、EMBASE、科学网、Cochrane图书馆和谷歌学术上的文章。将比值比（OR）及其95%置信区间（CI）用作二分类变量的效应指标。计算标准化均数差（SMD）及其95%CI作为合并的连续效应。选取了16项涉及2435例接受择期经皮冠状动脉介入治疗（PCI）患者的随机对照试验（RCT）。与对照组相比，RIPC可显著降低围手术期心肌梗死的发生率（OR = 0.64；95%CI：0.48 - 0.86；P = 0.003）和急性肾损伤的发生率（OR = 0.56；95%CI：0.322 - 0.99；P = 0.049）。Meta回归分析显示，对于多支血管病变的冠心病患者，RIPC对降低围手术期心肌梗死的作用增强（系数：-0.05[-0.09；-0.01]，P = 0.022）。两组肌钙蛋白I（P = 0.934）和C反应蛋白（P = 0.075）的变化无差异。
我们对RCT的荟萃分析表明，RIPC可为接受择期PCI的患者提供心脏和肾脏保护，而未报告其对降低PCI术后肌钙蛋白I和C反应蛋白水平有有益作用。
