Surrogate and clinical outcomes following ischemic postconditioning during primary percutaneous coronary intervention of ST‐Segment elevation myocardial infarction: A meta‐analysis of 15 randomized trials. Issue 6 (14th July 2014)

• Record Type: Journal Article
• Authors: Khalili, Houman; Patel, Vishal G.; Mayo, Helen G.; de Lemos, James A.; Brilakis, Emmanouil S.; Banerjee, Subhash; Bavry, Anthony A.; Bhatt, Deepak L.; Kumbhani, Dharam J.
• Is Part Of: Catheterization and cardiovascular interventions. Volume 84:Issue 6(2014:Nov. 15)
• Page Start: 978
• Page End: 986
• Publication Date: 2014-07-14
• Subjects: Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.25581
• Languages: English
• ISSNs: 1522-1946

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ccd25581-sec-1001" sec-type="section"> <title>Objectives</title> <p>To conduct a meta‐analysis on surrogate and clinical outcomes with myocardial ischemic postconditioning (IPoC) following revascularization with primary percutaneous intervention (PPCI) for ST‐segment myocardial infarction (STEMI) compared with PPCI alone.</p> </sec> <sec id="ccd25581-sec-2001" sec-type="section"> <title>Background</title> <p>Reperfusion injury remains an important problem following PPCI for STEMI. Trials of IPoC have mainly focused on cardiac biomarkers; the impact on clinical outcomes is unknown.</p> </sec> <sec id="ccd25581-sec-3001" sec-type="section"> <title>Methods</title> <p>Clinical trials that randomized STEMI patients to IPoC as compared with conventional PPCI were included for analysis.</p> </sec> <sec id="ccd25581-sec-4001" sec-type="section"> <title>Results</title> <p>A total of 15 randomized trials with 1, 545 patients met our selection criteria (785 underwent IPoC + PPCI, 760 PPCI alone). Mean follow‐up for clinical outcomes was 4.7 months. The mean ischemic time was 225 min. ST‐segment resolution (Relative Risk [RR] = 0.98; 95% Confidence Intervals [CI] 0.85–1.13; <italic>P</italic> = 0.75) and infarct size (Weighted mean difference [WMD] = −2.53%, 95% CI −6.10 to 1.05; <italic>P</italic> = 0.17) were similar between the IPoC + PPCI vs. PPCI arms. Left ventricular ejection fraction at follow‐up was marginally higher in the IPoC (WMD = 4.15%, 95% CI 0.19–8.12%, <italic>P</italic> = 0.04). No differences were noted in any of the clinical outcomes studied, including mortality (RR = 1.52; 95% CI 0.77–2.99; <italic>P</italic> = 0.23), recurrent MI (RR = 3.04; 95% CI 0.74–12.54; <italic>P</italic> = 0.12); stent thrombosis (RR = 1.24, 95% CI 0.51–3.04; <italic>P</italic> = 0.83) or the composite MACE outcome (RR = 1.53; 95% CI 0.89–2.63; <italic>P</italic> = 0.13). <bold>Conclusions:</bold> IPoC following PPCI is not associated with improvements in surrogate or clinical outcomes at 5 months as compared with PPCI alone. Our findings indicate no role for IPoC in the routine management of patients with STEMI. © 2014 Wiley Periodicals, Inc.</p> </sec> </abstract>