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C ardiac R emote I schemic P reconditioning Prior to E lective Vascular S urgery ( CRIPES ): A Prospective, Randomized, Sham ‐ Controlled Phase   II Clinical Trial

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ABSTRACT

Background: Remote ischemic preconditioning (RIPC) has been shown to reduce infarct size in animal models. We hypothesized that RIPC before an elective vascular operation would reduce the incidence and amount of a postoperative rise of the cardiac troponin level.

Methods and results: Cardiac Remote Ischemic Preconditioning Prior to Elective Vascular Surgery (CRIPES) was a prospective, randomized, sham‐controlled phase 2 trial using RIPC before elective vascular procedures. The RIPC protocol consisted of 3 cycles of 5‐minute forearm ischemia followed by 5 minutes of reperfusion. The primary endpoint was the proportion of subjects with a detectable increase in cardiac troponin I (cTnI) and the distribution of such increases. From June 2011 to September 2015, 201 male patients (69±7, years) were randomized to either RIPC (n=100) or a sham procedure (n=101). Indications for vascular surgery included an expanding abdominal aortic aneurysm (n=115), occlusive peripheral arterial disease of the lower extremities (n=37), or internal carotid artery stenosis (n=49). Of the 201 patients, 47 (23.5%) had an increase in cTnI above the upper reference limit within 72 hours of the vascular operation, with no statistically significant difference between those patients assigned to RIPC (n=22; 22.2%) versus sham procedure (n=25; 24.7%; P=0.67). Among the cohort with increased cTnI, the median peak values (interquartile range) in the RIPC and control group were 0.048 (0.004–0.174) and 0.017 (0.003–0.105), respectively (P=0.54).

Conclusions: In this randomized, controlled trial of men with increased perioperative cardiac risks, elevation in cardiac troponins was common following vascular surgery, but was not reduced by a strategy of RIPC.

Clinical trial registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01558596.

No MeSH data available.


Flow diagram of study patients. RIPC indicates remote ischemic preconditioning.
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jah31756-fig-0001: Flow diagram of study patients. RIPC indicates remote ischemic preconditioning.

Mentions: From June 2011 to September 2015, a total of 221 patients were enrolled in the study. Twenty subjects were excluded from the study before surgery for several reasons stated in the protocol (Figure 1). Therefore, the remaining 201 subjects were randomized to either RIPC (n=100) or a sham‐control procedure (n=101) before vascular surgery.


C ardiac R emote I schemic P reconditioning Prior to E lective Vascular S urgery ( CRIPES ): A Prospective, Randomized, Sham ‐ Controlled Phase   II Clinical Trial
Flow diagram of study patients. RIPC indicates remote ischemic preconditioning.
© Copyright Policy - creativeCommonsBy-nc-nd
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5121495&req=5

jah31756-fig-0001: Flow diagram of study patients. RIPC indicates remote ischemic preconditioning.
Mentions: From June 2011 to September 2015, a total of 221 patients were enrolled in the study. Twenty subjects were excluded from the study before surgery for several reasons stated in the protocol (Figure 1). Therefore, the remaining 201 subjects were randomized to either RIPC (n=100) or a sham‐control procedure (n=101) before vascular surgery.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Remote ischemic preconditioning (RIPC) has been shown to reduce infarct size in animal models. We hypothesized that RIPC before an elective vascular operation would reduce the incidence and amount of a postoperative rise of the cardiac troponin level.

Methods and results: Cardiac Remote Ischemic Preconditioning Prior to Elective Vascular Surgery (CRIPES) was a prospective, randomized, sham‐controlled phase 2 trial using RIPC before elective vascular procedures. The RIPC protocol consisted of 3 cycles of 5‐minute forearm ischemia followed by 5 minutes of reperfusion. The primary endpoint was the proportion of subjects with a detectable increase in cardiac troponin I (cTnI) and the distribution of such increases. From June 2011 to September 2015, 201 male patients (69±7, years) were randomized to either RIPC (n=100) or a sham procedure (n=101). Indications for vascular surgery included an expanding abdominal aortic aneurysm (n=115), occlusive peripheral arterial disease of the lower extremities (n=37), or internal carotid artery stenosis (n=49). Of the 201 patients, 47 (23.5%) had an increase in cTnI above the upper reference limit within 72 hours of the vascular operation, with no statistically significant difference between those patients assigned to RIPC (n=22; 22.2%) versus sham procedure (n=25; 24.7%; P=0.67). Among the cohort with increased cTnI, the median peak values (interquartile range) in the RIPC and control group were 0.048 (0.004–0.174) and 0.017 (0.003–0.105), respectively (P=0.54).

Conclusions: In this randomized, controlled trial of men with increased perioperative cardiac risks, elevation in cardiac troponins was common following vascular surgery, but was not reduced by a strategy of RIPC.

Clinical trial registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01558596.

No MeSH data available.