Key result
Large randomized controlled clinical trials of perioperative cardioprotective strategies have mostly revealed inconclusive, neutral, or negative results, failing to translate promising experimental evidence into improved clinical outcomes.
Why the study?
Translation of experimental cardioprotective strategies to improve clinical outcomes has been disappointing, with large randomized controlled trials showing mostly inconclusive, neutral, or negative results.
Do perioperative cardioprotective therapies improve clinical outcomes in patients undergoing surgery or percutaneous coronary intervention?
Systematic Review
Do perioperative cardioprotective therapies improve clinical outcomes in patients undergoing surgery or percutaneous coronary intervention?
Despite promising experimental data, perioperative cardioprotective strategies have largely failed to demonstrate significant clinical outcome improvements in large randomized trials.
Perioperative cardioprotection aims to minimize the consequences of myocardial ischemia-reperfusion injury. In isolated tissue and animal experiments, several treatments have been identified providing cardioprotection. Some of these strategies have been confirmed in clinical proof-of-concept studies. However, the final translation of cardioprotective strategies to really improve clinical outcome has been disappointing: large randomized controlled clinical trials mostly revealed inconclusive, neutral, or negative results. This review provides an overview of the currently available evidence regarding clinical implications of perioperative cardioprotective therapies from an anesthesiological perspective, highlighting nonpharmacological as well as pharmacological strategies. We discuss reasons why translation of promising experimental results into clinical practice and outcome improvement is hampered by potential confounders and suggest future perspectives to overcome these limitations.
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Roth et al. (2020) conducted a systematic review in Perioperative myocardial ischemia-reperfusion injury. Perioperative cardioprotective strategies vs. Placebo or standard care was evaluated. Large randomized controlled clinical trials of perioperative cardioprotective strategies have mostly revealed inconclusive, neutral, or negative results, failing to translate promising experimental evidence into improved clinical outcomes.
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