Effect of Remote Ischemic preConditioning on clinical outcomes in patients undergoing Coronary Artery bypass graft surgery | Clinical Trial - ERICCA

Mar 16, 2015
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Presenter/Author:
Derek J. Hausenloy, MB, ChB, PhD, FACC
Author/Summarized by Author:
Anthony A. Bavry, MD,MPH,FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Trial Sponsor:
British Heart Foundation
Date Presented:
03/16/2015
Original Posted Date:
03/16/2015
References

Description:

The goal of the trial was to assess the efficacy of remote ischemic preconditioning in reducing perioperative myocardial injury in patients undergoing coronary artery bypass grafting (CABG).

The ERICCA trial suggests that remote ischemic preconditioning does not impact on perioperative myocardial injury or 1-year cardiovascular outcomes in patients undergoing CABG.


Study Design

Patients were randomized in a 1:1 ratio to either remote ischemic preconditioning (n = 801) or sham control (n = 811). Remote ischemic preconditioning was performed using four 5-minute sequential cuff inflations and deflations. In the sham group, simulated cuff inflations were performed at the same frequency.

Inclusion criteria:

  • CABG ± valve surgery
  • On-pump blood cardioplegia
  • EuroSCORE ≥5

Patient population:

  • Total number of enrollees: 1,612
  • Duration of follow-up: 1 year
  • Mean patient age: 76 years
  • Percentage female: 30%
  • Percentage diabetics: 26%

Other salient features/characteristics:

  • Left ventricular ejection fraction: 52%
  • Lipid-lowering therapy: 81%
  • CABG + valve: 49%
  • Cardiopulmonary bypass time: 112 minutes

Principal Findings:

The primary composite outcome, cardiovascular death/myocardial infarction (MI)/stroke/coronary revascularization for remote ischemic preconditioning vs. sham was 26.6% vs. 28.0% (p = 0.95). Cardiovascular death: 5.7% vs. 3.9% (p = 0.1); MI: 21.8% vs. 23.7% (p = 0.43).

Secondary outcomes: perioperative AUC troponin T: 30,500 vs. 35,730

Interpretation:

The results of this trial indicate that remote ischemic preconditioning with the protocol followed in this trial does not impact on perioperative myocardial injury or 1-year cardiovascular outcomes in patients undergoing CABG. Other trials on ischemic and remote ischemic preconditioning in patients with STEMI have also shown mixed, but mostly negative results.

References:

Presented by Dr. Derek J. Hausenloy at ACC.15, San Diego, CA, March 16, 2015.

Keywords: ACC Annual Scientific Session, Acute Kidney Injury, Arteries, Coronary Artery Bypass, Ischemic Preconditioning, Myocardial Infarction, Myocardial Ischemia, Myocardial Revascularization, Stroke, Cardiac Surgical Procedures


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