Remote Ischemic Preconditioning for Prevention of Contrast-Associated Acute Kidney Injury following Coronary Angiography or Percutaneous Coronary Intervention.
Indu Ramachandra Rao, Ganesh Paramasivam, Shravana Acharya et al.
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In 30 seconds
This systematic review and meta-analysis pooled 36 randomized controlled trials involving 10,923 patients undergoing coronary angiography or percutaneous coronary intervention. Compared with sham preconditioning or usual care, remote ischemic preconditioning reduced contrast-associated acute kidney injury (risk ratio [RR], 0.54; 95% CI, 0.45 to 0.65; 30 RCTs, 5078 participants; high-certainty evidence). It probably also reduced in-hospital major adverse cardiovascular events (RR, 0.51; 95% CI, 0.26 to 0.98; four RCTs, 1266 participants; moderate-certainty evidence). No differences were found in dialysis, in-hospital mortality, 30-day mortality, or 30-day MACE.
Key findings
- Remote ischemic preconditioning reduced contrast-associated AKI: RR, 0.54; 95% CI, 0.45 to 0.65; 30 RCTs, 5078 participants.
- In-hospital MACE was probably reduced: RR, 0.51; 95% CI, 0.26 to 0.98; four RCTs, 1266 participants.
- There were no differences in dialysis, in-hospital mortality, 30-day mortality, or 30-day MACE.
Why it matters
Contrast-associated AKI is a relevant outcome around coronary angiographic procedures. This synthesis of randomized trials finds a reduction with remote ischemic preconditioning, supported by high-certainty evidence, while the apparent in-hospital cardiovascular benefit is less certain. The absence of differences in reported 30-day outcomes means the findings do not establish broader short-term kidney or cardiac benefit.
What to keep in mind
The abstract reports no significant differences in several outcomes, including 30-day kidney and cardiac outcomes; evidence certainty also differed by outcome, with moderate certainty for in-hospital MACE.