Clinical effect of postconditioning in ST-elevation myocardial infarction patients treated with primary percutaneous coronary intervention: a meta-analysis of randomized controlled trials

Abstract

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.

Adenosine triphosphate postconditioning is associated with better preserved global and regional cardiac function during myocardial ischemia and reperfusion: a speckle tracking imaging‐based echocardiologic study

“…29 These results suggest that STI-based echocardiography may be more sensitive for the detection of early preserved cardiac function by IPostC during the myocardial I/R process, and the improvement of cardiac functions may be one of the underlying contributors to the clinical benefits of IPostC for patients with IHD. 13 Another important finding in our study is that ATP-PPostC was associated with preserved cardiac function during the I/R process, which was comparable to the effects of IPostC. The clinical significance of the administration of ATP is that it is convenient and provides promising results in clinic, and this has served as an antiarrhythmic agent.…”

“…Moreover, it is noninvasive, objective and is not angular dependent or influenced by the effects of stretch, making it suitable for clinical use . These results suggest that STI‐based echocardiography may be more sensitive for the detection of early preserved cardiac function by IPostC during the myocardial I/R process, and the improvement of cardiac functions may be one of the underlying contributors to the clinical benefits of IPostC for patients with IHD …”

“…Postconditioning is a novel prophylactic and protective strategy for myocardial I/R injury . Indeed, clinical evidence has suggested that ischemic and pharmacologic postconditioning may attenuate I/R‐related myocardial injury for patients with IHD, who underwent the PCI process, in which ischemia postconditioning (IPostC) has been indicated to be associated with better preserved cardiac function and improved clinical outcomes . However, these studies mostly evaluated the global cardiac function, and its potential underlying mechanisms were poorly understood.…”

“…8,9 Indeed, clinical evidence has suggested that ischemic and pharmacologic postconditioning may attenuate I/Rrelated myocardial injury for patients with IHD, who underwent the PCI process, in which ischemia postconditioning (IPostC) has been indicated to be associated with better preserved cardiac function and improved clinical outcomes. [10][11][12][13] However, these studies mostly evaluated the global cardiac function, and its potential underlying mechanisms were poorly understood. Moreover, there have been reports that administration with adenosine triphosphate (ATP), which functions as a chemical energy transporter within cells for metabolism, may relieve the extent of myocardial I/R damage.…”

Roles of SIRT3 in heart failure: from bench to bedside

“…Early reperfusion is believed to be the most effective therapy to reduce myocardial damage induced by ischemia and hypoxia (Zhang and Huo, 2011), but the benefits of blood restoration are soon attenuated by reperfusion injury (Piper et al, 1998). Although some strategies, such as postconditioning, have been put forward to ameliorate the reperfusion injury, the incidences of total major cardiac events were not decreased (Hu et al, 2014). Several mechanisms have been discovered, including calcium overload, increased ROS formation, autophagy, apoptosis, and mitochondrial dysfunction (Murphy and Steenbergen, 2008;Marzetti et al, 2013).…”