A clinical study on the effect of Remote Ischemic Conditioning on atrial fibrillation and Outcome after coronary artery bypass grafting (RICO-trial)

Pre- and postconditioning describe mechanisms whereby short ischemic periods protect an organ against a longer period of ischemia. Interestingly, short ischemic periods of a limb, in itself harmless, may increase the ischemia tolerance of remote organs, e.g. the heart (remote conditioning, RC). Although several studies have shown reduced biomarker release by RC, a reduction of complications and improvement of patient outcome still has to be demonstrated. Atrial fibrillation (AF) is one of the most common complications after coronary artery
bypass graft surgery (CABG), affecting 27-46% of patients. It is associated with increased mortality, adverse cardiovascular events, and prolonged in-hospital stay. We hypothesize that remote ischemic pre- and/or postconditioning reduce the incidence of AF following CABG, and improve patient outcome.
This study is a randomized, controlled, patient and investigator blinded multicenter trial. Elective CABG patients are randomized to one of the following four groups: 1) control, 2) remote ischemic preconditioning, 3) remote ischemic postconditioning, or 4) remote ischemic pre- and postconditioning. Remote conditioning is applied at the arm by 3 cycles of 5 minutes of ischemia and reperfusion.
Primary endpoint is the incidence AF in the first 72 hours after surgery, detected using a Holter-monitor.
Secondary endpoints include length-of-stay on the intensive care unit and in-hospital, and the occurrence of major adverse cardiovascular events at 30 days, 3 months and 1 year.

  • Chief Investigator : Prof. Dr. B. Preckel (Academic Medical Center Amsterdam)
  • Sponsor :Academic Medical Center Amsterdam
  • National Coordinator :Dr. M. Momeni (UCL)
  • Investigators UZ Gent : Prof. Dr. S. De Hert, Dr. S. Bouchez
  • Timeline : start inclusion Jan 2010, duration 1-2 years with a 1-year follow-up
  • Clinical Trial.gov identifier : NCT01107184