Abstract
Reperfusion therapy is the most crucial strategy for rescuing ischemic myocardium and reducing infarction size. Cyclosporine A (CsA) can protect against reperfusion-induced myocardial necrosis. However, the clinical effects of CsA on myocardial infarction (MI) remain uncertain. This study investigated the effects of CsA on reperfusion injury (RI) in MI. We searched for and included articles regarding randomized controlled trials investigating the effect of CsA in patients with MI from PubMed, EMBASE, and Cochrane Library databases for an analysis. We then performed quality assessment, subgroup, sensitivity, and publication bias analyses. Of the 277 potentially relevant articles retrieved from the databases, only five were eligible for our meta-analysis. Compared with the placebos used in these studies, CsA did not reduce all-cause mortality [rate ratio (RR) 1.10, 95 % confidence interval (CI) 0.75–1.61; P = 0.533; I2 = 0 %) or adverse clinical events (RR 1.0, 95 % CI 0.89–1.13; P = 0.381; I2 = 6.5 %). In the CsA treatment groups, improvement in left ventricular ejection fraction (weighted mean difference = 1.91; 95 % CI 0.89, 2.92; P = 0.064) and reduction in MI size (standard mean difference = −0.41, 95 % CI −0.84 to 0.02; P = 0.519; I2 = 0.0 %) were minimal. The current meta-analysis indicates that CsA treatment does not reduce all-cause mortality and adverse clinical events in MI and that CsA may not have significant clinical effects on RI in MI.
Highlights
Myocardial infarction (MI) is a common disabling disease worldwide; in 2009, approximately 683,000 patients were discharged from US hospitals with a diagnosis of acute coronary syndrome
Characteristics of selected studies The five included articles were double-blinded randomized controlled trials (RCTs), in which cyclosporine A (CsA) was administered as an intravenous bolus dose (2.5 mg/kg)
The combined data from all RCTs did not show a significant association between CsA treatment and reduced all-cause mortality compared with the placebo (RR 1.10, 95 % confidence intervals (CIs) 0.75–1.61; P = 0.533; I2 = 0 %; Fig. 4)
Summary
Myocardial infarction (MI) is a common disabling disease worldwide; in 2009, approximately 683,000 patients were discharged from US hospitals with a diagnosis of acute coronary syndrome. A small-scale pilot study reported that compared with a placebo, CsA administration at the time of reperfusion is strongly associated with a smaller MI, according to some measures (Piot et al 2008). Another small-scale study reported that CsA treatment does not have beneficial effects on either MI size or other clinical outcomes (Ghaffari et al 2013). The most clinically relevant indicators of CsA treatment efficacy are reduced mortality and morbidity rates; these indicators generally require large samples and long follow-up periods. To clarify the efficacy of CsA therapy for MI, we performed a meta-analysis of relevant placebo-controlled RCTs for CsA treatment of RI in MI
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