Table 1. Overview of included studies.
| Study | Patientpopulation | Number of pat. | Groups | Form of remote conditioning | Endpoints | Results |
| Ali 2007 [34] | Open AAA* repair | 82 | Remote ischemic preconditioning VS control | Leg ischemia by clamping of the common iliac artery, 10 minutes left and 10 minutes right | Myocardial injury, asdefined by an increase inserum cardiac troponin>0,40 ng/ml Sec:myocardial infarction,kidney injury, death | Preconditioning reduced the risk of myocardial injury |
| Ali 2010 [21] | On-pump CABG† | 100 | Remote ischemic preconditioning VS control | Arm ischemia and reperfusion, by inflation of a cuff at 200 mmHg placed at the arm, for 3×5 minutes | CK-MB release | Remote ischemic conditioning reduced release of CK-MB postoperatively |
| Bøtker 2010 [33] | Primary PCI§ | 333 | Remote ischemic perconditioning VS control | Arm ischemia and reperfusion, by inflation of a cuff at 200 mmHg placed at the arm, for 4×5 minutes | Salvage index at 30 days measured by scintigraphy Sec.: Infarct size, troponin levels, death, reinfarction, hospitalization for heart-failure, LVEF§ | Remote ischemic conditioning increased salvage index, when corrected for ventricle size |
| Cheung 2006 [25] | Heart surgery for congenital defects | 37 | Remote ischemic preconditioning VS control | Leg ischemia and reperfusion, by inflation of a cuff at systolic pressure +15 mmHg placed at the leg, for 4×5 minutes | Troponin levels, mixedvenous saturation, urineoutput, inotropicdemand, lung function,systemic inflammatory response | Remote ischemic conditioning reduced myocardial injury |
| Choi 2011 [29] | Complex valve surgery | 76 | Remote ischemic preconditioning VS control | Leg ischemia and reperfusion, by inflation of a cuff at 250 mmHg placed at the leg, for 3×10 minutes | Kidney injury, asdefined by in increase inserum creatinine bymore than 50% or0.3 mg/dl(26.5 umol/L). Sec:CK, CK-MB levels | Remote ischemic preconditioning did not reduce kidney or myocardial injury |
| Günyadin 2000 [18] | On-pump CABG | 8 | Remote ischemic preconditioning VS control | Arm ischemia and reperfusion, by inflation of a cuff at 300 mmHg placed at the upper arm, for 2 cylci of 3 minutes ischemia and 2 minutes reperfusion | CK-MB and LDH release | Remote ischemic conditioning increased biomarker release |
| Hausenloy 2007 [16] | On-pump CABG | 66 | Remote ischemic preconditioning VS control | Arm ischemia and reperfusion, by inflation of a cuff at 200 mmHg placed at the arm, for 3×5 minutes | Troponin release | Remote ischemic conditioning reduced troponin release |
| Hong 2010 [38] | Off-pump CABG | 133 | Remote ischemic preconditioning VS control | Arm ischemia and reperfusion, by inflation of a cuff at 200 mmHg placed at the arm, for 4×5 minutes | Troponin release | Remote ischemic preconditioning did not significantly reduce troponin release |
| Hoole 2009 [31] | Elective PCI | 242 | Remote ischemic preconditioning VS control | Arm ischemia and reperfusion, by inflation of a cuff at 200 mmHg placed at the arm, for 3×5 minutes | Primary: Troponinlevels at 24 hoursSecondary: serumcreatinine, CRP,estimated GFR. MACE||rate at 6 months | Remote ischemic preconditioning reduced troponin levels |
| Iliodromitis 2006 [30] | Elective PCI | 41 | Remote ischemic preconditioning VS control | Arm ischemia and reperfusion, by inflation of a cuff at 200 mmHg placed at both arms, for 3×5 minutes | CRP, troponin, CK andCK-MB levels | Remote ischemic preconditioning increased the release of cardiac enzymes |
| Karuppasamy 2011 [24] | On-pump CABG surgery | 54 | Remote ischemic preconditioning VS control | Arm ischemia and reperfusion, by inflation of a cuff at 200 mmHg placed at both arms, for 3×5 minutes | Troponin and CK-MB | Remote ischemic preconditioning did not significantly reduce troponin release |
| Li 2010 [27] | Valve surgery | 81 | Remote ischemic preconditioning VS remote ischemic perconditioning VS control | Leg ischemia and reperfusion, by inflation of a cuff at 600 mmHg placed at the leg, for 3×4 minutes | Clinical data and troponin levels | Remote perconditioning, but not preconditioning, reduced troponin levels |
| Luo 2011 [28] | VSD** correction. | 60 | Remote ischemic preconditioning VS direct postconditioning VS control | Leg ischemia and reperfusion, by inflation of a cuff at 200–300 mmHg placed at the leg, for 3×5 minutes | CK-MB and troponin levels, clinical data | Remote ischemic conditioning reduced biomarker release |
| Rahman 2010 [22] | On-pump CABG | 162 | Remote ischemic preconditioning VS control | Arm ischemia and reperfusion, by inflation of a cuff at 200 mmHg placed at the arm, for 3×5 minutes | Primary: troponin release | Remote ischemic conditioning did not reduce troponin levels |
| Rentoukas 2010 [32] | Primary PCI | 96 | Remote ischemic perconditioning VS remote ischemic perconditioning plus morphine VS control | Arm ischemia and reperfusion, by inflation of a cuff at 200 mmHg placed at the arm, for 3×5 minutes | Primary endpoint: achievement of full ST-segment resolution Secondary: peak troponin | Remote ischemic conditioning increased the achievement of ST-segment resolution |
| Thielmann 2010 [20] | On-pump CABG | 53 | Remote ischemic preconditioning VS control | Arm ischemia and reperfusion, by inflation of a cuff at 200 mmHg placed at the arm, for 3×5 minutes | Primary: Troponinlevels. Secondary:Mortality, major adversecardiovascular eventsand renal function | Remote ischemic conditioning reduced troponin release |
| Venugopal 2009 [17] | On-pump CABG, +/− AVR# | 45 | Remote ischemic preconditioning VS control | Arm ischemia and reperfusion, by inflation of a cuff at 200 mmHg placed at the arm, for 3×5 minutes | Troponin levels | Remote ischemic conditioning reduced troponin release |
| Venugopal 2010 [15] | On-pump CABG, +/− AVR (retrospective analysis of 2 prior studies) | 78 | Remote ischemic conditioning VS control | Arm ischemia and reperfusion, by inflation of a cuff at 200 mmHg placed at the arm, for 3×5 minutes | Kidney injury, defined as an increase of 25 umol/L | Remote ischemic conditioning reduced kidney injury |
| Wagner 2010 [19] | On-pump CABG, +/− valve surgery | 101 | Late remote ischemic preconditioning (18 hours before surgery) VS control VS tramadol | Arm ischemia and reperfusion, by inflation of a cuff at systolic pressure plus 40 mmHg placed at the arm, for 3×5 minutes | Troponin release | Remote ischemic conditioning reduced troponin release |
| Walsh 2009 [35] | Endovascular AAA repair | 40 | Remote ischemic preconditioning VS control | Leg ischemia and reperfusion, by inflation of a cuff placed at the thigh to a pressure that ensured absence of flow by echo-Doppler, 10 minutes of 1 leg,then 10 minutes of the other leg | Primary: kidney injury,measured byalbumin:creatinin ratioand retinol bindingprotein in urineSecondary: serumcreatinin and GFR | Remote ischemic conditioning did not significantly reduce kidney injury |
| Walsh 2010 [36] | Open AAA repair | 40 | Remote ischemic preconditioning VS control | Leg ischemia by clamping of the common iliac artery, 10 minutes left and 10 minutes right | Primary: kidney injury,measured byalbumin:creatinin ratioand retinol bindingprotein in urineSecondary: serumcreatinin and GFR | Remote ischemic conditioning did not reduce kidney injury |
| Walsh 2010 [37] | Carotid endarteriectomy | 70 | Remote ischemic conditioning VS control | Leg ischemia and reperfusion, by inflation of a cuff placed at the thigh to a pressure that ensured absence of flow by echo-Doppler, 10 minutes of 1 leg, then 10 minutes of the other leg | Primary: saccadic latency, troponin release Secondary: major adverse cardiovascular events | Remote ischemic conditioning did not significantly improve saccadic latency or troponin release |
| Zhou 2010 [26] | VSD repair | 60 | Combined late and early remote ischemic preconditioning VS control | Arm ischemia and reperfusion, by inflation of a cuff at 240 mmHg placed at the arm, for 3×5 minutes | Heart and lung function, inflammatory markers | Remote ischemic preconditioning had mixed effects on heart and lung function and inflammatory markers |
| Zimmerman 2011 [23] | On-pump cardiac surgery | 60 | Preconditioning VS no intervention | Leg ischemia and reperfusion, by inflation of surgical tourniquet to 200 mmHg placed at the thigh for 3×5 minutes | Kidney injury (increase of serum creatinine by >26.5 mmol/L) | Reduction in incidence of post-operative kidney injury by preconditioning |
*
abdominal aortic aneurysm; †coronary artery bypass grafting; ‡percutaneous coronary intervention; §left ventricular ejection fraction; ||major adverse cardiovascular event; #aortic valve replacement; **ventricular septal defect.