Effect of Modified Remote Ischemic Preconditioning on Perioperative Outcomes of CABG Patients With CPB

Objective: To investigate the effect of modified remote ischemic preconditioning (MRIC) on perioperative outcomes in patients undergoing coronary artery bypass grafting (CABG) on cardiopulmonary bypass (CPB). Methods: This study included 118 patients who planned to undergo CABG surgery at the Affiliated Hospital of Xuzhou Medical University. These patients were randomly divided into the MRIC group ( n = 40), remote ischemic preconditioning (RIPC) group ( n = 39), or control group ( n = 39). The MRIC group received 3 cycles of 5 min ischemia/5 min reperfusion on the left upper limb at 2 days, 1 day, and 2 h preoperatively. The RIPC group received RIPC 2 h preoperatively, while the control group did not receive ischemic preconditioning. The STS score of patients was calculated according to the coronary angiography results and clinical data for risk stratification. The serum concentrations of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP), creatine kinase MB (CK‐MB), high‐sensitivity cardiac troponin‐T (hs‐cTnT), and creatinine (Cr) of patients were recorded at postoperative 0, 12th, 24th, 48th, 72th h , and seventh days for each patient. Major adverse cardiac events (MACEs) in the hospital were recorded. Results: A total of 118 participants were included. The overall MACE incidence was 83.4%. A total of 36 MACE cases (92.3%) occurred in the control group, 28 cases (70.0%) in the MRIC group (RR: 0.75; 95% CI: 0.61–0.95), and 35 cases (89.7%) in the RIPC group (RR: 0.97; 95% CI: 0.84–1.12). Compared to the control group, MRIC and RIPC groups had lower concentrations of CK‐MB at postoperative 0 and 12th h ( p < 0.05); MRIC group had lower concentrations of hs‐cTnT at postoperative 12th h ( p < 0.05). The MRIC group had a higher concentration of NT‐proBNP at postoperative 24th, 48th, and 72th h ( p < 0.05). The differences in the concentration of Cr among the three groups were not statistically significant ( p > 0.05); There was no statistically significant difference in the effects of MRIC on the indexes of the low‐risk patients and the medium‐high‐risk patients ( p > 0.05). Conclusion: (1) MRIC has cardioprotective effects and reduces the occurrence of postoperative MACE. (2) MRIC could not reduce the concentrations of NT‐proBNP and Cr postoperatively. (3) MRIC showed no significant difference in myocardial protection in patients with different STS score risk stratifications.