Remote Ischemic Preconditioning for Renal and Cardiac Protection in Congestive Heart Failure (RICH) Trial

Remote Ischemic Preconditioning for Renal and Cardiac Protection in Congestive Heart Failure (RICH) Trial

This is a prospective, double-blind, sham-controlled, multicenter, randomized clinical trial is to study the effects of remote ischemic preconditioning on contrast-associated acute kidney injury, functional capacity, and major adverse kidney events in in patients with congestive heart failure undergoing cardiac catheterization and/or percutaneous coronary intervention.

The RICH Trial is a prospective, multicenter, randomized clinical trial to determine the effect of remote ischemic preconditioning on contrast associated acute kidney injury, and to characterize the effect of remote ischemic preconditioning on brain natriuretic peptide, functional capacity at one month, and major adverse kidney events (persistent renal dysfunction, renal replacement therapy, and death) at three months in patients with congestive heart failure with reduced left ventricular ejection fraction undergoing coronary angiography and/or percutaneous coronary intervention.

Inclusion Criteria:

• Age 18 years
• Diagnosis of heart failure with reduced LVEF <50%
• Pre-procedure intravenous normal saline fluid restriction status
• Society for Cardiovascular Angiography and Interventions (SCAI) AKI risk score (>1%)
• Referral for coronary angiogram and/or PCI
• Suspected stable coronary artery disease or acute coronary syndrome

Exclusion Criteria:

• Inability to give informed consent
• Unstable BP (SBP > 200 or <80 mmHg) at the time of enrolment
• Upper limb peripheral arterial disease
• Unavailability of at least one arm for RIPC/Sham-RIPC application
• Kidney transplant
• Renal disease requiring dialysis
• Prior exposure to contrast media within 72hrs preceding coronary angiography
• Pregnancy
• Prisoner