Long-term remote ischemic preconditioning to improve heart blood flow and outcomes after CABG

Long-term Remote Ischemic Preconditioning Improves Myocardial Perfusion and Prognosis of Patients After Coronary Artery Bypass Grafting

This trial tries whether repeated arm‑cuff blood‑flow interruptions (remote ischemic preconditioning) can improve heart blood flow and outcomes for people having CABG.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 210 (estimated)
• Ages: 18 Years to 80 Years
• Sex: All
• Sponsor: Henan Institute of Cardiovascular Epidemiology (Academic / other)
• Locations: 1 site (Zhengzhou, Henan)
• Trial ID: NCT04779008 on ClinicalTrials.gov

What this trial studies

A total of 210 patients with three‑vessel coronary disease scheduled for CABG are randomized 1:1:1 into three groups (70 each): a repeated RIPC group receiving one preoperative RIPC and daily post‑operative RIPC for 1 year, a single RIPC group receiving one preoperative RIPC only, and a control group receiving no RIPC. RIPC is delivered as four cycles of 5 minutes of upper‑arm ischemia by cuff inflation to 200 mmHg alternating with 5 minutes of reperfusion. Myocardial blood flow is quantitatively measured at 7 days and 3 months, blood biomarkers (VEGF, nitric oxide, adenosine, endothelin‑1) are tracked, and MACCE (cardiovascular death, nonfatal MI, unplanned revascularization, stroke) is recorded at 6 and 12 months. The trial is conducted at Fuwai Central China Cardiovascular Hospital (Zhengzhou, Henan) with in‑person cuff treatments and imaging follow‑ups.

Who should consider this trial

Good fit: Ideal candidates are adults with three‑vessel coronary artery disease scheduled for elective CABG who can tolerate arm‑cuff ischemia, are not taking glibenclamide or nicorandil, and can provide informed consent.

Not a fit: Patients who may not receive benefit include those with upper‑limb peripheral vascular disease, recent acute MI with cardiogenic shock, severe organ dysfunction, uncontrolled severe hypertension, pregnancy, inability to tolerate RIPC, or those on interfering medications such as glibenclamide or nicorandil.

Why it matters

Potential benefit: If successful, repeated RIPC could improve myocardial perfusion after CABG and reduce major cardiovascular events such as heart attack, stroke, or repeat revascularization.

How similar studies have performed: Two large randomized trials showed that a single preoperative RIPC reduced perioperative troponin release but did not improve long‑term outcomes, making prolonged daily RIPC a relatively novel and less‑tested approach.

Eligibility criteria

Inclusion Criteria:

* Three coronary artery lesions, CABG surgery was planned

Exclusion Criteria:

* The patients could not tolerate ripc;
* peripheral vascular disease affecting upper limbs
* Acute myocardial infarction complicated with cardiogenic shock，in recent 30 days,
* Emergency cases
* Severe structural heart disease and severe arrhythmia ；
* The uncontrolled systolic blood pressure and diastolic blood pressure of severe hypertension were 180 mmHg and 120 mmHg respectively;
* Severe liver, renal and pulmonary disease
* Mental disorder can't cooperate;
* Inability to give informed consent；
* Patients on glibenclamide or nicorandil, as these medications may interfere with RIC
* pregnant;

Where this trial is running

Zhengzhou, Henan

• Fuwai central China cardiovascular Hospital — Zhengzhou, Henan, China (Recruiting)

Study contacts

• Principal investigator: Muwei Li, Ph.D — Fuwai central China cardiovascular hospotial
• Study coordinator: Quan Guo, MD

Conditions Coronary Disease