Remote ischemic preconditioning reduces the incidence of contrast-induced nephropathy in patients undergoing coronary angiography/intervention: Systematic review and meta-analysis of randomized controlled trials

Raymond Pranata, Alexander E. Tondas, Rachel Vania, Mangiring P.L. Toruan, Antonia A. Lukito, Bambang B. Siswanto

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Abstract

Background: Contrast-induced nephropathy (CIN) is associated with increased mortality and morbidity in patients undergoing coronary angiography (CAG) and percutaneous coronary intervention (PCI). We aimed to assess the latest evidence on the effect of remote ischemic preconditioning (RIPC) on the incidence of CIN in patients undergoing CAG/PCI. Methods: We performed a comprehensive search on topics assessing RIPC and CIN in CAG/PCI patients from inception up until July 2019 through several electronic databases. Results: There were a total of 1,925 subjects from 14 randomized controlled trials. Remote ischemic preconditioning was associated with reduced CIN incidence in patients undergoing CAG/PCI (OR 0.41 [0.30, 0.55], p <.001; I2: 22%). The nephroprotective effect was also demonstrated in those at moderate-high risk for CIN subgroup (OR 0.41 [0.29, 0.58], p <.001; I2: 26%) and PCI-only subgroup (OR 0.41 [0.29, 0.58], p <.001; I2: 0%). Time from RIPC to CAG/PCI has similar effectiveness among ≤45, ≤60, and ≤120 min. Mortality, rehospitalization, hemodialysis, and major adverse events were lower in the RIPC group (OR 0.50 [0.33, 0.76], p =.001; I2: 0%). Grading of recommendations assessment, development and evaluation (GRADE) assessment showed that RIPC has high evidence certainty for reducing CIN in patients undergoing PCI/CAG, moderate-high risk subgroup, and PCI-only subgroup with absolute reduction of 97 per 1,000, 129 per 1,000, and 121 per 1,000, respectively. Harbord test showed no evidence for the presence of small-study effects (p =.157). Conclusions: Remote ischemic preconditioning is an effective procedure to reduce the risk of CIN and should be considered in patients with moderate-high risk at developing CIN.

Original languageEnglish
JournalCatheterization and Cardiovascular Interventions
DOIs
Publication statusAccepted/In press - 1 Jan 2020

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Ischemic Preconditioning
Percutaneous Coronary Intervention
Coronary Angiography
Meta-Analysis
Randomized Controlled Trials
Incidence
Mortality
Renal Dialysis
Databases
Morbidity

Keywords

  • contrast-induced nephropathy
  • coronary angiography
  • coronary artery disease
  • percutaneous coronary intervention
  • remote ischemic preconditioning

Cite this

@article{b85ae8698d3b4f138d1b8b3819a44e97,
title = "Remote ischemic preconditioning reduces the incidence of contrast-induced nephropathy in patients undergoing coronary angiography/intervention: Systematic review and meta-analysis of randomized controlled trials",
abstract = "Background: Contrast-induced nephropathy (CIN) is associated with increased mortality and morbidity in patients undergoing coronary angiography (CAG) and percutaneous coronary intervention (PCI). We aimed to assess the latest evidence on the effect of remote ischemic preconditioning (RIPC) on the incidence of CIN in patients undergoing CAG/PCI. Methods: We performed a comprehensive search on topics assessing RIPC and CIN in CAG/PCI patients from inception up until July 2019 through several electronic databases. Results: There were a total of 1,925 subjects from 14 randomized controlled trials. Remote ischemic preconditioning was associated with reduced CIN incidence in patients undergoing CAG/PCI (OR 0.41 [0.30, 0.55], p <.001; I2: 22{\%}). The nephroprotective effect was also demonstrated in those at moderate-high risk for CIN subgroup (OR 0.41 [0.29, 0.58], p <.001; I2: 26{\%}) and PCI-only subgroup (OR 0.41 [0.29, 0.58], p <.001; I2: 0{\%}). Time from RIPC to CAG/PCI has similar effectiveness among ≤45, ≤60, and ≤120 min. Mortality, rehospitalization, hemodialysis, and major adverse events were lower in the RIPC group (OR 0.50 [0.33, 0.76], p =.001; I2: 0{\%}). Grading of recommendations assessment, development and evaluation (GRADE) assessment showed that RIPC has high evidence certainty for reducing CIN in patients undergoing PCI/CAG, moderate-high risk subgroup, and PCI-only subgroup with absolute reduction of 97 per 1,000, 129 per 1,000, and 121 per 1,000, respectively. Harbord test showed no evidence for the presence of small-study effects (p =.157). Conclusions: Remote ischemic preconditioning is an effective procedure to reduce the risk of CIN and should be considered in patients with moderate-high risk at developing CIN.",
keywords = "contrast-induced nephropathy, coronary angiography, coronary artery disease, percutaneous coronary intervention, remote ischemic preconditioning",
author = "Raymond Pranata and Tondas, {Alexander E.} and Rachel Vania and Toruan, {Mangiring P.L.} and Lukito, {Antonia A.} and Siswanto, {Bambang B.}",
year = "2020",
month = "1",
day = "1",
doi = "10.1002/ccd.28709",
language = "English",
journal = "Catheterization and Cardiovascular Interventions",
issn = "1522-1946",
publisher = "Wiley-Liss Inc.",

}

TY - JOUR

T1 - Remote ischemic preconditioning reduces the incidence of contrast-induced nephropathy in patients undergoing coronary angiography/intervention

T2 - Systematic review and meta-analysis of randomized controlled trials

AU - Pranata, Raymond

AU - Tondas, Alexander E.

AU - Vania, Rachel

AU - Toruan, Mangiring P.L.

AU - Lukito, Antonia A.

AU - Siswanto, Bambang B.

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Background: Contrast-induced nephropathy (CIN) is associated with increased mortality and morbidity in patients undergoing coronary angiography (CAG) and percutaneous coronary intervention (PCI). We aimed to assess the latest evidence on the effect of remote ischemic preconditioning (RIPC) on the incidence of CIN in patients undergoing CAG/PCI. Methods: We performed a comprehensive search on topics assessing RIPC and CIN in CAG/PCI patients from inception up until July 2019 through several electronic databases. Results: There were a total of 1,925 subjects from 14 randomized controlled trials. Remote ischemic preconditioning was associated with reduced CIN incidence in patients undergoing CAG/PCI (OR 0.41 [0.30, 0.55], p <.001; I2: 22%). The nephroprotective effect was also demonstrated in those at moderate-high risk for CIN subgroup (OR 0.41 [0.29, 0.58], p <.001; I2: 26%) and PCI-only subgroup (OR 0.41 [0.29, 0.58], p <.001; I2: 0%). Time from RIPC to CAG/PCI has similar effectiveness among ≤45, ≤60, and ≤120 min. Mortality, rehospitalization, hemodialysis, and major adverse events were lower in the RIPC group (OR 0.50 [0.33, 0.76], p =.001; I2: 0%). Grading of recommendations assessment, development and evaluation (GRADE) assessment showed that RIPC has high evidence certainty for reducing CIN in patients undergoing PCI/CAG, moderate-high risk subgroup, and PCI-only subgroup with absolute reduction of 97 per 1,000, 129 per 1,000, and 121 per 1,000, respectively. Harbord test showed no evidence for the presence of small-study effects (p =.157). Conclusions: Remote ischemic preconditioning is an effective procedure to reduce the risk of CIN and should be considered in patients with moderate-high risk at developing CIN.

AB - Background: Contrast-induced nephropathy (CIN) is associated with increased mortality and morbidity in patients undergoing coronary angiography (CAG) and percutaneous coronary intervention (PCI). We aimed to assess the latest evidence on the effect of remote ischemic preconditioning (RIPC) on the incidence of CIN in patients undergoing CAG/PCI. Methods: We performed a comprehensive search on topics assessing RIPC and CIN in CAG/PCI patients from inception up until July 2019 through several electronic databases. Results: There were a total of 1,925 subjects from 14 randomized controlled trials. Remote ischemic preconditioning was associated with reduced CIN incidence in patients undergoing CAG/PCI (OR 0.41 [0.30, 0.55], p <.001; I2: 22%). The nephroprotective effect was also demonstrated in those at moderate-high risk for CIN subgroup (OR 0.41 [0.29, 0.58], p <.001; I2: 26%) and PCI-only subgroup (OR 0.41 [0.29, 0.58], p <.001; I2: 0%). Time from RIPC to CAG/PCI has similar effectiveness among ≤45, ≤60, and ≤120 min. Mortality, rehospitalization, hemodialysis, and major adverse events were lower in the RIPC group (OR 0.50 [0.33, 0.76], p =.001; I2: 0%). Grading of recommendations assessment, development and evaluation (GRADE) assessment showed that RIPC has high evidence certainty for reducing CIN in patients undergoing PCI/CAG, moderate-high risk subgroup, and PCI-only subgroup with absolute reduction of 97 per 1,000, 129 per 1,000, and 121 per 1,000, respectively. Harbord test showed no evidence for the presence of small-study effects (p =.157). Conclusions: Remote ischemic preconditioning is an effective procedure to reduce the risk of CIN and should be considered in patients with moderate-high risk at developing CIN.

KW - contrast-induced nephropathy

KW - coronary angiography

KW - coronary artery disease

KW - percutaneous coronary intervention

KW - remote ischemic preconditioning

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U2 - 10.1002/ccd.28709

DO - 10.1002/ccd.28709

M3 - Article

C2 - 31912996

AN - SCOPUS:85077971421

JO - Catheterization and Cardiovascular Interventions

JF - Catheterization and Cardiovascular Interventions

SN - 1522-1946

ER -