Protection Against Postoperative Atrial Fibrillation Via Antiplatelet Aggregation Induced by Remote Ischemic Preconditioning During Off-Pump Coronary Artery Bypass Grafting.

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