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<p>Off-pump coronary artery bypass grafting (OPCABG) is associated with increased platelet aggregation and a higher incidence of postoperative atrial fibrillation (POAF). Remote ischemic preconditioning (RIPC) has been reported as a promising intervention to mitigate these adverse outcomes. Consecutive patients with cytochrome P450 family 2 subfamily C member 19 (CYP2C19) loss-of-function (LOF) genotype who underwent isolated OPCABG were randomly assigned to receive intermittent ischemia–reperfusion applied to the arm (RIPC group)&#xa0;or not intervention (control group). RIPC was performed after induction of anesthesia using three cycles of 5-min inflation separated by 5-min deflation. The primary outcome was&#xa0;the&#xa0;cumulative incidence of POAF&#xa0;within the&#xa0;first postoperative week, assessed by the intention-to-treat analysis. Secondary outcomes&#xa0;included POAF burden, biochemical indicators, and clinical trajectory. Among the 220 patients available for the primary endpoint analysis, POAF occurred in 27 of 109 patients (24.8%) in the RIPC group versus 46 of 111 patients (41.4%) in the control group (hazard ratio [HR]: 0.542, 95% confidence interval [CI]: 0.342 to 0.858; P = 0.01). The RIPC group also showed significantly lower values than the control group for AF burden (5.1% [IQR 2.3–11.3%] vs. 8.3% [IQR 4.1–19.1%]; P = 0.019), arachidonic acid- and adenosine diphosphate-stimulated platelet aggregation, inflammatory and prothrombotic index, and intensive care unit length of stay. In CYP2C19 LoF carriers, administration of RIPC favorably reduced the incidence and burden of POAF within 1 week after OPCABG, attenuated platelet aggregation and systemic inflammation, and shortened the duration of intensive care unit stay.</p>

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Protection against postoperative atrial fibrillation via antiplatelet aggregation induced by remote ischemic preconditioning during off-pump coronary artery bypass grafting

  • 期刊论文

  • 发表日期：

    2026年7月3日

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  • Qin Jiang,
  • Yi Zheng,
  • Keli Huang,
  • Juan Du,
  • Zhenglin Yang,
  • Shengshou Hu

摘要

Off-pump coronary artery bypass grafting (OPCABG) is associated with increased platelet aggregation and a higher incidence of postoperative atrial fibrillation (POAF). Remote ischemic preconditioning (RIPC) has been reported as a promising intervention to mitigate these adverse outcomes. Consecutive patients with cytochrome P450 family 2 subfamily C member 19 (CYP2C19) loss-of-function (LOF) genotype who underwent isolated OPCABG were randomly assigned to receive intermittent ischemia–reperfusion applied to the arm (RIPC group) or not intervention (control group). RIPC was performed after induction of anesthesia using three cycles of 5-min inflation separated by 5-min deflation. The primary outcome was the cumulative incidence of POAF within the first postoperative week, assessed by the intention-to-treat analysis. Secondary outcomes included POAF burden, biochemical indicators, and clinical trajectory. Among the 220 patients available for the primary endpoint analysis, POAF occurred in 27 of 109 patients (24.8%) in the RIPC group versus 46 of 111 patients (41.4%) in the control group (hazard ratio [HR]: 0.542, 95% confidence interval [CI]: 0.342 to 0.858; P = 0.01). The RIPC group also showed significantly lower values than the control group for AF burden (5.1% [IQR 2.3–11.3%] vs. 8.3% [IQR 4.1–19.1%]; P = 0.019), arachidonic acid- and adenosine diphosphate-stimulated platelet aggregation, inflammatory and prothrombotic index, and intensive care unit length of stay. In CYP2C19 LoF carriers, administration of RIPC favorably reduced the incidence and burden of POAF within 1 week after OPCABG, attenuated platelet aggregation and systemic inflammation, and shortened the duration of intensive care unit stay.