Postconditioning in patients treated with primary percutaneous coronary intervention: an updated meta-analysis

Catheter Cardiovasc Interv. 2013 Nov 1;82(5):E662-71. doi: 10.1002/ccd.25095. Epub 2013 Jul 19.

Abstract

Objective: The aim of present analysis was to evaluate the effect of postconditioning in primary percutaneous coronary intervention (pPCI).

Background: Although postconditioning in pPCI has shown potential favorable effects on reperfusion injury, recent trials have yielded divergent results.

Methods: Randomized controlled trials were identified using relevant databases published up to August 15, 2012. Weighted mean difference (WMD) and standardized mean difference (SMD) were calculated using meta-analysis through fixed- or random-effects models. Statistical analysis was performed using RevMan 5.17 and Stata 12.0.

Results: Thirteen studies providing myocardial biomarkers, left ventricular ejection fraction (LVEF) or infarct size evaluated by cardiac magnetic resonance (CMR) in a total of 725 ST-elevation acute myocardial infarction (STEMI) patients were identified. Compared with usual care, postconditioning significantly reduced myocardial injury biomarkers (SMD = -0.61; 95% Confidence Interval (CI): [-0.98, -0.23]; P = 0.001; I(2) = 78%). Univariate meta-regression analysis suggested potential source of heterogeneity were the type of biomarkers and the use of glycoprotein IIb/IIIa inhibitors (I(2) reg = 44.84% and 67.24%, respectively; R(2) = 91.53% and 49.46%, respectively). Secondary analysis showed statistical significant improvement of LVEF with postconditioning (WMD = 3.22%; 95%CI: [0.88%, 5.57%]; P = 0.007; I(2) = 60%) relative to usual care. The effect diminished during medium (<6 months) and long terms (≥6 months) (P = 0.86 and 0.15, respectively). There was no significant decrease in infarct size among patients treated with postconditioning compared to usual care (SMD = 0.20; 95%CI: [-0.03, 0.43]; P = 0.08; I(2) = 46%).

Conclusion: In STEMI patients undergoing pPCI, postconditioning is associated with significant lower level of myocardial injury biomarkers and a statistical significant improvement of LVEF relative to usual care. However, this adjunctive therapy may fails to reduce infarct size evaluated by CMR.

Keywords: cardioprotection; myocardial infarction; reperfusion injury.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Biomarkers / blood
  • Chi-Square Distribution
  • Humans
  • Ischemic Postconditioning* / methods
  • Magnetic Resonance Imaging
  • Myocardial Infarction / blood
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / physiopathology
  • Myocardial Infarction / therapy*
  • Myocardium / pathology
  • Percutaneous Coronary Intervention* / adverse effects
  • Recovery of Function
  • Risk Factors
  • Stroke Volume
  • Time Factors
  • Treatment Outcome
  • Ventricular Function, Left

Substances

  • Biomarkers