Cardioprotection by remote ischemic conditioning: Mechanisms and clinical evidences

Table 1 Clinical studies on remote ischemic conditioning in percutaneous coronary intervention

Ref.	Patients n (CTRLS/RIPC)	ST or LT outcome	Conditioning protocol			Primary endpoint	Results
			I/R cycles	Cuff pressure	Limb		RIPC	CTRLS	P
Remote ischemic preconditioning
Prasad et al[73], 2013	48/47	ST	3 × 3’	200 mmHg	Upper	Post-PCI myonecrosis (cTnT ≥ 0.03 ng/dL)	40%	47%	0.42
Ahmed et al[76], 2013	72/77	ST	3 × 5’	200 mmHg	Upper	cTnT 16 h post-PCI	0.02 ng/mL	0.047 ng/mL	0.047
Ghaemian et al[77], 2010	40/40	ST	2 × 5’	Above systolic	Lower	TnT 24 h post-PCI	12.50%	40%	0.01
Hoole et al[74], 2009	117/125	ST	3 × 5’	200 mmHg	Upper	cTnI 24 h post-PCI	0.06 ng/mL	0.16 ng/mL	0.04
Luo e et al[78], 2013	104/101	ST	3 × 5’	200 mmHg	Upper	hs-cTnI 16 h post-PCI	0.11 ng/mL	0.21 ng/mL	< 0.01
Xu et al[79], 2014	98/102	ST	3 × 5’	200 mmHg	Upper	hs-cTnI 16 h post-PCI	0.29 ng/mL	0.38 ng/mL	0.256
Davies et al[75], 2013	117/125	LT	3 × 5’	200 mmHg	Upper	MACCE (6 yr follow up)	23	36	0.039
Bøtker et al[81], 2010	167/166	ST	4 × 5’	200 mmHg	Upper	MSI after 30 d	0.75	0.55	0.033
Sloth et al[82], 2014	167/166	LT	4 × 5’	200 mmHg	Upper	MACCE rates (5 yr follow-up)	25.60%	13.50%	0.018
Carrasco-Chinchilla et al[83], 2013	114/118	ST	3 × 5’	200 mmHg	Upper	TnI 24 h post-PCI	0.476 ng/mL	0.478 ng/mL	0.378

cTnI: Cardiac troponin I; cTnT: Cardiac Tro-ponin T; CTRLS: Controls; hs-cTnT: High sensitivity cardiac troponin T; I/R: Ische-mia/reperfusion; MACCE: Major adverse cardiac and cerebral events; RIPC: Remote ischemic preconditioning; ST: Short term; LT: Long term.

Table 2 Clinical studies on remote ischemic preconditioning before elective coronary artery bypass graft surgery

Ref.	Patients n (CTRLS/RIPC)	RIPC protocol			Primaryendpoint	Results			Notes
		I/R cycles	Cuff pressure	Limb		RIPC	CTRLS	P	β-blockers	Isoflurane, desflurane
Short terms results
Hausenloy et al[88], 2007	30/27	3 × 5 min	200 mmHg	Upper	cTnT at				+	+
					6 h	0.31 mcg/L	0.59 mcg/L	0.039
					12 h	0.37mcg/L	0.69 mcg/L	0.002
					24 h	0.30 mcg/L	0.52 mcg/L	0.003
					48 h	0.30 mcg/L	0.52 mcg/L	0.036
					72 h	0.25 mcg/L	0.48 mcg/L	0.111
Wagner et al[90], 2010	35/33	3 × 5 min	40 mmHg above systolic pressure	Upper	cTnI at 8 h	2.54 mcg/L	2.90 mcg/L	0.043	-	-
Ali et al[91], 2010	50/50	3 × 5 min	200 mmHg	Upper	CK-MB at
					8 h	27.22 IU/L	30.24 IU/L	0.026	+	NS
					16 h	33.3 IU/L	37.2 IU/L	0.021
					24 h	22.74 IU/L	25.22 IU/L	0.052
					48 h	17.20 IU/L	19.72 IU/L	0.003
Lomivorotov et al[93], 2012	40/40	3 × 5 min	200 mmHg	Upper	48 h cTnI AUC	54.4 ng/mL	53.3 ng/mL	> 0.05	+	+
Thielmann et al[102], 2013	167/162	3 × 5 min	200 mmHg	Upper	72 h cTnI AUC	266 ng/mL	321 ng/mL	0.022	+	+
Rahman et al[95], 2010	55	3 × 5 min	200 mmHg	Upper	48 h cTnT AUC	30 ng/mL	28 ng/mL	0.721	+	+
Lucchinetti et al[94], 2012	28/27	4 × 5 min	400 mmHg	Lower	72 h hs-cTnT AUC	11708 pg/mL	9574 pg/mL	0.33	+	+
Long term results
Thielmann et al[102], 2013	167/162	3 × 5 min	200 mmHg	Upper	ACE at 1.54 yr death MACCE	3 8	11 23	0.046 0.005	+	+
Lucchinetti et al[94], 2012	28/27	4 × 5 min	400 mmHg	Lower	ACE at 6 mo death rehospitalization	0 3	1 3	1.00 1.00	+	+

ACE: Adverse cardiovascular events; AUC: Area under the curve; cTnI: Cardiac troponin I; cTnT: Cardiac Troponin T; CTRLS: Controls; hs-cTnT: High sensitivity cardiac troponin T; I/R: Ischemia/reperfusion; MACCE: Major adverse cardiac and cerebral events; NS: Not specified; RIPC: Remote ischemic preconditioning.