Abstract
ObjectiveThis systematic review was designed to evaluate the efficacy of remote ischemic conditioning (RIC) with primary percutaneous coronary intervention (PCI) versus primary PCI alone for ST-segment elevation myocardial infarction (STEMI).Search strategyComputerized search for trials from PubMed, EMBASE, CENTRAL and Cochrane Database of Systematic Reviews databases.Selection criteriaTrials investigating RIC plus primary PCI (group A) versus primary PCI alone (group B).Outcome measuresMyocardial enzyme levels; left ventricular ejection fraction (LVEF); major adverse cardiac and cerebrovascular events (MACCEs); TIMI flow grade III; myocardial salvage index or infarct size per patients.ResultsIn all, 14 studies involving 3165 subjects were included. There was a significant association of myocardial edema levels, myocardial salvage index and incidence of MACCEs in group A compared with group B (myocardial edema levels: SMD = − 0.36, 95% CI (− 0.59, − 0.13); myocardial salvage index: MD = 0.06, 95% CI (0.02, 0.10); MACCE: OR = 0.70, 95% CI (0.57, 0.85)). With regard to infarct size, TIMI flow grade III and LVEF, group A appeared to be equivalent with group B (infarct size: MD = − 1.67, 95% CI (− 3.46, 0.11); TIMI flow grade III: OR = 1.04, 95% CI (0.71, 1.52); LVEF: MD = 0.74, 95% CI (− 0.80, 2.28)).ConclusionRIC was associated with lower myocardial edema levels, myocardial salvage index and incidence of MACCE, while non-significant beneficial effect on infarct size, TIMI flow grade III or LVEF. These findings suggest that RIC is a promising adjunctive treatment to PCI for the prevention of reperfusion injury in STEMI patients.
Highlights
Percutaneous coronary intervention (PCI), with its full and lasting opening infarct-related artery, has become one of the most effective means for treating ST-segment elevation myocardial infarction (STEMI) [1]
There was a significant association of myocardial edema levels, myocardial salvage index and incidence of major adverse cardiac and cerebrovascular events (MACCEs) in group A compared with group B (myocardial edema levels: standardized MD (SMD) = − 0.36, 95% confidence interval (CI) (− 0.59, − 0.13); myocardial salvage index: Mean difference (MD) = 0.06, 95% CI (0.02, 0.10); MACCE: Odds ratios (OR) = 0.70, 95% CI (0.57, 0.85))
Remote ischemic conditioning (RIC) was associated with lower myocardial edema levels, myocardial salvage index and incidence of MACCE, while non-significant beneficial effect on infarct size, TIMI flow grade III or left ventricular ejection fraction (LVEF)
Summary
Percutaneous coronary intervention (PCI), with its full and lasting opening infarct-related artery, has become one of the most effective means for treating ST-segment elevation myocardial infarction (STEMI) [1]. During percutaneous transluminal coronary angioplasty, balloon inflation and deflation were used to achieve interruption and recovery of blood flow This method can reduce the myocardial infarct size, protect coronary artery endothelial function and reduce the ischemic myocardium inflammatory response and other cardiac protection, similar to ischemic preconditioning, and this method is called ischemic postconditioning [7]. Myocardial ischemic preconditioning and postconditioning can produce cardio-protective effects and reduce myocardial ischemia-reperfusion injury, it is itself traumatic and presents a variety of potential risks, which reduces its clinical feasibility. Remote ischemic conditioning (RIC) is easy to operate and has few side effects It protects important vital organs through ischemic preconditioning of organs. It will be of great clinical value to conduct in-depth research on it.
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