Remote ischemic preconditioning reduces the incidence of contrast-induced nephropathy in patients undergoing coronary angiography/intervention: Systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Contrast-induced nephropathy (CIN) is associated with increased mortality and morbidity in patients undergoing coronary angiography (CAG) and percutaneous coronary intervention (PCI). We aimed to assess the latest evidence on the effect of remote ischemic preconditioning (RIPC) on the incidence of CIN in patients undergoing CAG/PCI. METHODS: We performed a comprehensive search on topics assessing RIPC and CIN in CAG/PCI patients from inception up until July 2019 through several electronic databases. RESULTS: There were a total of 1,925 subjects from 14 randomized controlled trials. Remote ischemic preconditioning was associated with reduced CIN incidence in patients undergoing CAG/PCI (OR 0.41 [0.30, 0.55], p < .001; I(2) : 22%). The nephroprotective effect was also demonstrated in those at moderate-high risk for CIN subgroup (OR 0.41 [0.29, 0.58], p < .001; I(2) : 26%) and PCI-only subgroup (OR 0.41 [0.29, 0.58], p < .001; I(2) : 0%). Time from RIPC to CAG/PCI has similar effectiveness among