Cardiac Remote Ischemic Preconditioning Prior to Elective Vascular Surgery (CRIPES): A prospective, randomized, sham-controlled phase II clinical trial

Santiago Garcia, Thomas S. Rector, Marina Zakharova, Rebekah R. Herrmann, Selcuk Adabag, Stefan Bertog, Yader Sandoval, Steve Santilli, Emmanouil S. Brilakis, Edward O. McFalls

Research output: Contribution to journalArticle

18 Scopus citations

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.

Original languageEnglish (US)
Article numbere003916
JournalJournal of the American Heart Association
Volume5
Issue number10
DOIs
StatePublished - Oct 1 2016

Keywords

  • Remote preconditioning
  • Troponins
  • Vascular surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Cardiac Remote Ischemic Preconditioning Prior to Elective Vascular Surgery (CRIPES): A prospective, randomized, sham-controlled phase II clinical trial'. Together they form a unique fingerprint.

  • Cite this