{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:38:19Z","timestamp":1787017099827,"version":"build-2736575974"},"reference-count":30,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"accepted":{"date-parts":[[2014,8,28]]},"published-print":{"date-parts":[[2015,2,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Remote ischaemic preconditioning (RIPC), using brief cycles of limb ischaemia\/reperfusion, is a non-invasive, low-cost intervention that may reduce perioperative myocardial injury (PMI) in patients undergoing cardiac surgery. We investigated whether RIPC can also improve short-term clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>One hundred and eighty patients undergoing elective coronary artery bypass graft (CABG) surgery and\/or valve surgery were randomised to receive either RIPC (2\u20135\u2005min cycles of simultaneous upper arm and thigh cuff inflation\/deflation; N=90) or control (uninflated cuffs placed on the upper arm and thigh; N=90). The study primary end point was PMI, measured by 72\u2005h area under the curve (AUC) serum high-sensitive troponin-T (hsTnT); secondary end point included short-term clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>RIPC reduced PMI magnitude by 26% (\u22129.303 difference (CI \u221215.618 to \u22122.987) 72\u2005h hsTnT-AUC; p=0.003) compared with control. There was also evidence that RIPC reduced the incidence of postoperative atrial fibrillation by 54% (11% RIPC vs 24% control; p=0.031) and decreased the incidence of acute kidney injury by 48% (10.0% RIPC vs 21.0% control; p=0.063), and intensive care unit stay by 1\u2005day (2.0\u2005days RIPC (CI 1.0 to 4.0) vs 3.0\u2005days control (CI 2.0 to 4.5); p=0.043). In a post hoc analysis, we found that control patients administered intravenous glyceryl trinitrate (GTN) intraoperatively sustained 39% less PMI compared with those not receiving GTN, and RIPC did not appear to reduce PMI in patients given GTN.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>RIPC reduced the extent of PMI in patients undergoing CABG and\/or valve surgery. RIPC may also have beneficial effects on short-term clinical outcomes, although this will need to be confirmed in future studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov ID:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT00397163\">NCT00397163<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/heartjnl-2014-306178","type":"journal-article","created":{"date-parts":[[2014,9,25]],"date-time":"2014-09-25T02:38:47Z","timestamp":1411612727000},"page":"185-192","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":153,"title":["Effect of remote ischaemic preconditioning on clinical outcomes in patients undergoing cardiac bypass surgery: a randomised controlled clinical trial"],"prefix":"10.1136","volume":"101","clinical-trial-number":[{"clinical-trial-number":"nct00397163","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct01107184","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct01247545","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct01067703","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Luciano","family":"Candilio","sequence":"first","affiliation":[{"name":"The Hatter Cardiovascular Institute, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul","family":"Malik","sequence":"additional","affiliation":[{"name":"The Hatter Cardiovascular Institute, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cono","family":"Ariti","sequence":"additional","affiliation":[{"name":"The Nuffield Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Barnard","sequence":"additional","affiliation":[{"name":"The Heart Hospital, University College London Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmelo","family":"Di Salvo","sequence":"additional","affiliation":[{"name":"The Heart Hospital, University College London Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Lawrence","sequence":"additional","affiliation":[{"name":"The Heart Hospital, University College London Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Hayward","sequence":"additional","affiliation":[{"name":"The Heart Hospital, University College London Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Yap","sequence":"additional","affiliation":[{"name":"The Heart Hospital, University College London Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Roberts","sequence":"additional","affiliation":[{"name":"The Heart Hospital, University College London Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"Sheikh","sequence":"additional","affiliation":[{"name":"The Heart Hospital, University College London Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shyam","family":"Kolvekar","sequence":"additional","affiliation":[{"name":"The Heart Hospital, University College London Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek J","family":"Hausenloy","sequence":"additional","affiliation":[{"name":"The Hatter Cardiovascular Institute, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek M","family":"Yellon","sequence":"additional","affiliation":[{"name":"The Hatter Cardiovascular Institute, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2014,9,24]]},"reference":[{"key":"2025100705143065000_101.3.185.1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehp134"},{"key":"2025100705143065000_101.3.185.2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.87.3.893"},{"key":"2025100705143065000_101.3.185.3","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvn114"},{"key":"2025100705143065000_101.3.185.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61296-3"},{"key":"2025100705143065000_101.3.185.5","doi-asserted-by":"publisher","DOI":"10.1007\/s00395-010-0104-5"},{"key":"2025100705143065000_101.3.185.6","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.926667"},{"key":"2025100705143065000_101.3.185.7","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2008.155770"},{"key":"2025100705143065000_101.3.185.8","first-page":"427","article-title":"Induced remote ischaemic pre-conditioning on ischaemia-reperfusion injury in patients undergoing coronary artery bypass","volume":"20","author":"Ali","year":"2010","journal-title":"J Coll Physicians Surg Pak"},{"key":"2025100705143065000_101.3.185.9","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-11-1068"},{"key":"2025100705143065000_101.3.185.10","doi-asserted-by":"publisher","DOI":"10.1007\/s00395-012-0256-6"},{"key":"2025100705143065000_101.3.185.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2010.11.018"},{"key":"2025100705143065000_101.3.185.12","doi-asserted-by":"publisher","DOI":"10.1093\/icvts\/ivs118"},{"key":"2025100705143065000_101.3.185.13","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2011-300860"},{"key":"2025100705143065000_101.3.185.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2010.06.016"},{"key":"2025100705143065000_101.3.185.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2006.01.066"},{"key":"2025100705143065000_101.3.185.16","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-009-9536-9"},{"key":"2025100705143065000_101.3.185.17","doi-asserted-by":"publisher","DOI":"10.1007\/s00395-011-0185-9"},{"key":"2025100705143065000_101.3.185.18","doi-asserted-by":"publisher","DOI":"10.1186\/cc2872"},{"key":"2025100705143065000_101.3.185.19","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(01)03330-6"},{"key":"2025100705143065000_101.3.185.20","doi-asserted-by":"publisher","DOI":"10.1258\/jrsm.2012.120049"},{"key":"2025100705143065000_101.3.185.21","doi-asserted-by":"publisher","DOI":"10.1007\/s10557-013-6451-3"},{"key":"2025100705143065000_101.3.185.22","doi-asserted-by":"publisher","DOI":"10.1161\/hc3201.092218"},{"key":"2025100705143065000_101.3.185.23","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.805242"},{"key":"2025100705143065000_101.3.185.24","doi-asserted-by":"crossref","unstructured":"Crystal E Garfinkle MS Connolly SS . Interventions for preventing post-operative atrial fibrillation in patients undergoing heart surgery. Cochrane Database Syst Rev 2004;(4):CD003611.","DOI":"10.1002\/14651858.CD003611.pub2"},{"key":"2025100705143065000_101.3.185.25","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2253-11-11"},{"key":"2025100705143065000_101.3.185.26","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.00240605"},{"key":"2025100705143065000_101.3.185.27","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2010.07.014"},{"key":"2025100705143065000_101.3.185.28","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2011.156"},{"key":"2025100705143065000_101.3.185.29","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-011-0397-x"},{"key":"2025100705143065000_101.3.185.30","first-page":"1423","article-title":"Remote ischaemic preconditioning for heart surgery. The study design for a multi-center randomized double-blinded controlled clinical trial\u2014the RIPHeart-Study","volume":"33","author":"Meybohm","year":"2012","journal-title":"Eur Heart J"}],"container-title":["Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/heartjnl-2014-306178","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T12:17:20Z","timestamp":1759839440000},"score":1,"resource":{"primary":{"URL":"https:\/\/heart.bmj.com\/lookup\/doi\/10.1136\/heartjnl-2014-306178"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,9,24]]},"references-count":30,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2015,1,14]]},"published-print":{"date-parts":[[2015,2,1]]}},"alternative-id":["10.1136\/heartjnl-2014-306178"],"URL":"https:\/\/doi.org\/10.1136\/heartjnl-2014-306178","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.718891668.793533009","asserted-by":"object"}]},"ISSN":["1355-6037","1468-201X"],"issn-type":[{"value":"1355-6037","type":"print"},{"value":"1468-201X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,9,24]]}}}