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Remote Ischemic Preconditioning Pre-CABG Ups Outcomes

Cutting off and restoring blood supply in the arm linked to lower myocardial injury
FRIDAY, Aug. 16 (HealthDay News) -- In patients undergoing coronary artery bypass surgery, using a blood pressure cuff to cut off and restore blood supply in the arm before surgery is associated with lower myocardial injury and better long-term survival, according to a study published in the Aug. 17 issue of The Lancet.
Matthias Thielmann, M.D., from Universitatsklinikum Essen in Germany, and colleagues randomly assigned 329 patients undergoing coronary artery bypass graft surgery to receive remote ischemic preconditioning (after inducing anesthesia, three cycles of 5 min ischemia and 5 min reperfusion in the left upper arm via a blood pressure cuff) or no remote ischemic preconditioning.
As determined by the concentration of cardiac troponin I in the first 72 hours after surgery, the researchers found that the remote ischemic preconditioning group had significantly lower myocardial injury (266 ng/mL versus 321 ng/mL cardiac troponin I; geometric mean area under the curve ratio compared with no intervention of 0.83 for the intention-to-treat population and 0.79 in the per-protocol analysis). Over 1.54 years, the remote ischemic preconditioning group also had significantly lower all-cause mortality (hazard ratio, 0.27).
"Remote ischemic preconditioning provided perioperative myocardial protection and improved the prognosis of patients undergoing elective coronary artery bypass graft surgery," Thielmann and colleagues conclude.
Abstract (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61450-6/abstract )Full Text (subscription or payment may be required) (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61450-6/fulltext )Editorial (subscription or payment may be required) (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61607-4/fulltext )
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