A systematic review and meta-analysis evaluating ischemic conditioning during percutaneous coronary intervention

David I Blusztein; Matthew J Brooks; David T Andrews

doi:10.2217/fca-2017-0042

A systematic review and meta-analysis evaluating ischemic conditioning during percutaneous coronary intervention

Future Cardiol. 2017 Nov;13(6):579-592. doi: 10.2217/fca-2017-0042. Epub 2017 Oct 27.

Authors

David I Blusztein¹, Matthew J Brooks², David T Andrews^{3

4}

Affiliations

¹ Cardiology Registrar, Department of Cardiology, The Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria 3050, Australia.
² Cardiologist, Department of Cardiology, The Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria 3050, Australia.
³ Honorary Clinical Associate Professor, Department of Anesthesia, Perioperative & Pain Medicine Unit, The University of Melbourne, Grattan St, Parkville, 3052, Australia.
⁴ Visiting Anesthetist, Department of Anesthesia & Pain Management, The Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria 3050, Australia.

PMID: 29076346
DOI: 10.2217/fca-2017-0042

Abstract

Aim: A systematic review and meta-analysis, evaluating ischemic conditioning during percutaneous coronary intervention (PCI).

Methods & results: A database search of randomized trials of ischemic conditioning in PCI created three subgroups for meta-analysis: mortality in elective PCI with remote ischemic preconditioning (RIPreC; subgroup 1a, n = 3) - no outcome difference between RIPreC and control (odds ratio: 0.34; 95% CI: 0.08-1.56), myocardial salvage index in ST-elevation myocardial infarction (STEMI) with RIPreC (subgroup 1b, n = 2) - favored RIPreC (mean difference: 0.13; 95% CI: 0.07-0.19), and infarct size in STEMI with local ischemic postconditioning (LIPostC) (subgroup 4b, n = 12) - favored LIPostC (mean difference: -4.13 g.m^-2; 95% CI: -7.36 to -0.90 g.m^-2).

Conclusion: RIPreC and LIPostC improve myocardial salvage index and myocardial infarct size respectively in PCI for STEMI. No mortality benefit detected with RIPreC in elective PCI.

Keywords: cardioprotection; ischemia-reperfusion injury; ischemic conditioning; meta-analysis; myocardial infarction; percutaneous coronary intervention.

Publication types

Evaluation Study
Meta-Analysis
Review
Systematic Review

MeSH terms

Cardiac Catheterization / methods
Coronary Angiography / methods
Elective Surgical Procedures / methods
Elective Surgical Procedures / mortality
Electrocardiography / methods
Emergency Treatment / methods
Emergency Treatment / mortality
Female
Humans
Ischemic Postconditioning / methods*
Ischemic Preconditioning, Myocardial / methods*
Male
Monitoring, Intraoperative / methods*
Percutaneous Coronary Intervention / methods*
Prognosis
Randomized Controlled Trials as Topic
Risk Assessment
ST Elevation Myocardial Infarction / diagnostic imaging
ST Elevation Myocardial Infarction / surgery*
Survival Analysis
Treatment Outcome