Remote XXXX conditioning and cardioprotection: a systematic review and meta-analysis of randomized clinical trials.

@entity1 @entity296 @entity63 @entity741 @entity299 @entity583
Remote @entity63 conditioning (RIC) represents an innovative cardioprotective method that has been investigated in numerous clinical studies providing miscellaneous results. This systematic review and meta-analysis sought to assess RIC-induced effects on @entity296 biomarkers and clinical outcomes in clinical situations at risk of @entity741 /reperfusion damage. PubMed and Cochrane databases were searched for randomized clinical trials testing any RIC protocol versus a control in a situation or procedure at risk of @entity299 /reperfusion damage, including coronary angioplasty and cardiac or major vascular surgery. Data were collected from publications reporting biological markers of @entity296 or clinical events, including major adverse cardiovascular and cerebral events (MACCE), all-cause mortality, @entity583 incidence, and repeat revascularization. Standardized mean difference (SMD) (continuous outcomes) and odds ratios (OR) (dichotomous outcomes) were compared between groups. Heterogeneity was investigated by means of meta-analysis regression. A total of 53 articles (44 studies) were identified by the search, with 5,317 @entity1 included in the systematic meta-analysis. RIC significantly reduced troponin area under curve (AUC) (SMD -0.27, 95  % confidence interval (CI): [-0.36, -0.18]; p  <  0.01) and troponin peak (SMD: -0.22, 95  % CI: [-0.30, -0.15]; p  <  0.01). The same reduction was observed with creatine kinase MB (CK-MB) AUC and peak. Long-term MACCE and all-cause mortality were significantly lower in the RIC group (OR: 0.42, 95  % CI [0.28, 0.64]; p  <  0.01 vs. OR: 0.27, 95  % CI [0.13, 0.58]; p  <  0.01, respectively), as was @entity583 incidence (OR: 0.54, 95  % CI [0.40, 0.73]; p  <  0.01). We observed no difference regarding repeat revascularization. RIC appears to be an effective method for reducing @entity63 /reperfusion @entity296 , and our findings suggest that it may reduce long-term clinical events.
