Similar articles

Abstract: Objective: To evaluate the clinical effect of postconditioning on patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). Methods: Randomized controlled trials were identified by searching relevant databases published up to April 2nd, 2014. A meta-analysis of eligible studies was performed by Stata 12.0 and Review Manager 5.2 with a fixed-effect model. Results: Ten studies providing adverse cardiac events in a total of 1346 STEMI patients treated with primary PCI were identified. The occurrence of heart failure was significantly reduced in patients treated with postconditioning compared with usual care (risk ratio (RR) 0.533; 95% confidence intervals (CI) 0.368–0.770), whereas non-fatal reinfarction slightly increased in the postconditioning group (RR 2.746; 95% CI 1.007–7.488). No significant difference in total major adverse cardiac events (MACEs) was observed between the two groups (RR 0.876; 95% CI 0.671–1.144). Conclusions: postconditioning in STEMI patients undergoing primary PCI significantly reduces the risk of heart failure, but fails to decrease the incidence of total MACEs and the risk of non-fatal reinfarction.

后适应在接受直接PCI治疗的急性ST段抬高性心肌梗死患者中的临床疗效：基于随机对照试验的meta分析

[1]Argaud, L., Gateau-Roesch, O., Raisky, O., et al., 2005. Postconditioning inhibits mitochondrial permeability transition. Circulation, 111(2):194-197.

[2]Bavry, A.A., Kumbhani, D.J., Bhatt, D.L., 2008. Role of adjunctive thrombectomy and embolic protection devices in acute myocardial infarction: a comprehensive meta-analysis of randomized trials. Eur. Heart J., 29(24):2989-3001.

[3]Burzotta, F., de Vita, M., Gu, Y.L., et al., 2009. Clinical impact of thrombectomy in acute ST-elevation myocardial infarction: an individual patient-data pooled analysis of 11 trials. Eur. Heart J., 30(18):2193-2203.

[4]Cohen, M.V., Yang, X.M., Downey, J.M., 2007. The pH hypothesis of postconditioning: staccato reperfusion reintroduces oxygen and perpetuates myocardial acidosis. Circulation, 115(14):1895-1903.

[5]de Luca, G., Dudek, D., Sardella, G., et al., 2008. Adjunctive manual thrombectomy improves myocardial perfusion and mortality in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction: a meta-analysis of randomized trials. Eur. Heart J., 29(24):3002-3010.

[6]de Silva, K., Webb, I., Sicard, P., et al., 2012. Does left ventricular function continue to influence mortality following contemporary percutaneous coronary intervention? Coron. Artery Dis., 23(3):155-161.

[7]di Chiara, A., Dall'armellina, E., Badano, L.P., et al., 2010. Predictive value of cardiac troponin-I compared to creatine kinase-myocardial band for the assessment of infarct size as measured by cardiac magnetic resonance. J. Cardiovasc. Med., 11(8):587-592.

[8]Dong, M., Mu, N., Guo, F., et al., 2014. The beneficial effects of postconditioning on no-reflow phenomenon after percutaneous coronary intervention in patients with ST-elevation acute myocardial infarction. J. Thromb. Thrombolysis, 38(2):208-214.

[9]Egger, M., Smith, G.D., Schneider, M., et al., 1997. Bias in meta-analysis detected by a simple, graphical test. BMJ, 315(7109):629-634.

[10]Eitel, I., Wohrle, J., Suenkel, H., et al., 2013. Intracoronary compared with intravenous bolus abciximab application during primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: cardiac magnetic resonance substudy of the AIDA STEMI trial. J. Am. Coll. Cardiol., 61(13):1447-1454.

[11]Elżbieciak, M., Wita, K., Grabka, M., et al., 2013. Effect of postconditioning on infarction size, adverse left ventricular remodeling, and improvement in left ventricular systolic function in patients with first anterior ST-segment elevation myocardial infarction. Pol. Arch. Med. Wewn., 123(6):268-276.

[12]Freixa, X., Bellera, N., Ortiz-Perez, J.T., et al., 2012. Ischaemic postconditioning revisited: lack of effects on infarct size following primary percutaneous coronary intervention. Eur. Heart J., 33(1):103-112.

[13]Garcia, S., Henry, T.D., Wang, Y.L., et al., 2011. Long-term follow-up of patients undergoing postconditioning during ST-elevation myocardial infarction. J. Cardiovasc. Transl. Res., 4(1):92-98.

[14]Granfeldt, A., Lefer, D.J., Vinten-Johansen, J., 2009. Protective ischaemia in patients: preconditioning and postconditioning. Cardiovasc. Res., 83(2):234-246.

[15]Hahn, J.Y., Song, Y.B., Kim, E.K., et al., 2013. Ischemic postconditioning during primary percutaneous coronary intervention: the effects of postconditioning on myocardial reperfusion in patients with ST-segment elevation myocardial infarction (POST) randomized trial. Circulation, 128(17):1889-1896.

[16]Hausenloy, D.J., Yellon, D.M., 2008. Preconditioning and postconditioning: new strategies for cardioprotection. Diabetes Obes. Metab., 10(6):451-459.

[17]Higgins, J.P.T., Green, S., 2011. Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0. The Cochrane Collaboration. Available from http://www.cochrane-handbook.org [Accessed on Mar. 20, 2011].

[18]Kahn, H.A., Sempos, C.T., 2000. Statistical methods in meta-analysis. In: Petitti, D.B. (Ed.), Meta-Analysis, Decision Analysis, and Cost-Effectiveness Analysis, 2nd Ed. Oxford University Press, New York, p.94-118.

[19]Kloner, R.A., Jennings, R.B., 2001. Consequences of brief ischemia: stunning, preconditioning, and their clinical implications: Part 2. Circulation, 104(25):3158-3167.

[20]Laskey, W.K., 2005. Brief repetitive balloon occlusions enhance reperfusion during percutaneous coronary intervention for acute myocardial infarction: a pilot study. Catheter. Cardiovasc. Interv., 65(3):361-367.

[21]Lim, S.Y., Davidson, S.M., Hausenloy, D.J., et al., 2007. Preconditioning and postconditioning: the essential role of the mitochondrial permeability transition pore. Cardiovasc. Res., 75(3):530-535.

[22]Limalanathan, S., Andersen, G.O., Klow, N.E., et al., 2014. Effect of ischemic postconditioning on infarct size in patients with ST-elevation myocardial infarction treated with primary PCI results of the POSTEMI (POstconditioning in ST-Elevation Myocardial Infarction) randomized trial. J. Am. Heart Assoc., 3(2):e000679.

[23]Lønborg, J., Kelbaek, H., Vejlstrup, N., et al., 2010a. Cardioprotective effects of ischemic postconditioning in patients treated with primary percutaneous coronary intervention, evaluated by magnetic resonance. Circ. Cardiovasc. Interv., 3(1):34-41.

[24]Lønborg, J., Holmvang, L., Kelbaek, H., et al., 2010b. ST-segment resolution and clinical outcome with ischemic postconditioning and comparison to magnetic resonance. Am. Heart J., 160(6):1085-1091.

[25]Ma, X., Zhang, X., Li, C., et al., 2006. Effect of postconditioning on coronary blood flow velocity and endothelial function and LV recovery after myocardial infarction. J. Interv. Cardiol., 19(5):367-375.

[26]Murry, C.E., Jennings, R.B., Reimer, K.A., 1986. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation, 74(5):1124-1136.

[27]Mykytenko, J., Kerendi, F., Reeves, J.G., et al., 2007. Long-term inhibition of myocardial infarction by postconditioning during reperfusion. Basic Res. Cardiol., 102(1):90-100.

[28]Piper, H.M., Meuter, K., Schafer, C., 2003. Cellular mechanisms of ischemia-reperfusion injury. Ann. Thorac. Surg., 75(2):S644-S648.

[29]Solomon, S.D., Anavekar, N., Skali, H., et al., 2005. Influence of ejection fraction on cardiovascular outcomes in a broad spectrum of heart failure patients. Circulation, 112(24):3738-3744.

[30]Sörensson, P., Saleh, N., Bouvier, F., et al., 2010. Effect of postconditioning on infarct size in patients with ST elevation myocardial infarction. Heart, 96(21):1710-1715.

[31]Sörensson, P., Ryden, L., Saleh, N., et al., 2013. Long-term impact of postconditioning on infarct size and left ventricular ejection fraction in patients with ST-elevation myocardial infarction. BMC Cardiovasc. Disord., 13:22.

[32]Staat, P., Rioufol, G., Piot, C., et al., 2005. Postconditioning the human heart. Circulation, 112(14):2143-2148.

[33]Steg, P.G., James, S.K., Atar, D., et al., 2012. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur. Heart J., 33(20):2569-2619.

[34]Tang, X.L., Sato, H., Tiwari, S., et al., 2006. Cardioprotection by postconditioning in conscious rats is limited to coronary occlusions <45 min. Am. J. Physiol. Heart Circ. Physiol., 291(5):H2308-H2317.

[35]Tarantini, G., Favaretto, E., Marra, M.P., et al., 2012. Postconditioning during coronary angioplasty in acute myocardial infarction: the POST-AMI trial. Int. J. Cardiol., 162(1):33-38.

[36]Thibault, H., Piot, C., Staat, P., et al., 2008. Long-term benefit of postconditioning. Circulation, 117(8):1037-1044.

[37]Tierney, J.F., Stewart, L.A., Ghersi, D., et al., 2007. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials, 8:16.

[38]Vlaar, P.J., Svilaas, T., van der Horst, I.C., et al., 2008. Cardiac death and reinfarction after 1 year in the Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS): a 1-year follow-up study. Lancet, 371(9628):1915-1920.

[39]Wang, L., Wang, J., Xu, H., et al., 2013. Postconditioning in patients treated with primary percutaneous coronary intervention: an updated meta-analysis. Catheter. Cardiovasc. Interv., 82(5):E662-E671.

[40]Wei, Y., Ruan, L., Zhou, G., et al., 2012. Local ischemic postconditioning during primary percutaneous coronary intervention: a meta-analysis. Cardiology, 123(4):225-233.

[41]Yang, X.C., Liu, Y., Wang, L.F., et al., 2007. Reduction in myocardial infarct size by postconditioning in patients after percutaneous coronary intervention. J. Invasive Cardiol., 19(10):424-430.

[42]Yellon, D.M., Hausenloy, D.J., 2007. Myocardial reperfusion injury. N. Engl. J. Med., 357(11):1121-1135.

[43]Zhang, Z., Xu, X., Ni, H., 2013. Small studies may overestimate the effect sizes in critical care meta-analyses: a meta-epidemiological study. Crit. Care, 17(1):R2.

[44]Zhao, Z.Q., Corvera, J.S., Halkos, M.E., et al., 2003. Inhibition of myocardial injury by ischemic postconditioning during reperfusion: comparison with ischemic preconditioning. Am. J. Physiol. Heart Circ. Physiol., 285(2):H579-H588.