Abstract
We conducted a systematic review and meta-analysis to evaluate the effects of remote ischemic conditioning on myocardial parameters and clinical outcomes in ST segment elevation acute myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention. Ten eligible randomized controlled trials with 1006 STEMI patients were identified. Compared with controls, remote ischemic conditioning reduced the myocardial enzyme levels (standardized mean difference =-0.86; 95% CI: -1.44 to -0.28; P = 0.004; I2 = 94.5%), and increased the incidence of complete ST-segment resolution [odds ratio (OR) = 1.74; 95% CI: 1.09 to 2.77; P = 0.02; I2 = 47.9%]. Remote ischemic conditioning patients had a lower risk of all-cause mortality (OR = 0.27; 95% CI: 0.12 to 0.62; P = 0.002; I2 = 0.0%) and lower major adverse cardiovascular and cerebrovascular events rate (OR=0.45; 95% CI: 0.27 to 0.75; P = 0.002; I2 = 0.0%). Meta-analysis suggested that remote ischemic conditioning conferred cardioprotection by reducing myocardial enzymes and increasing the incidence of complete ST-segment resolution in patients after STEMI. As a result, clinical outcomes were improved in terms of mortality and incidence of major adverse cardiovascular and cerebrovascular events.
Highlights
Reperfusion to ischemic myocardium after ST segment elevation acute myocardial infarction (STEMI) can result in obvious myocardial ischemia/reperfusion (I/R) injury, which may impair the clinical benefit of primary percutaneous coronary intervention (PPCI) [1]
All-cause mortality was reported in five trials[7, 9,10,11,12], incidence of heart failure (HF) in three [7, 11, 12], recurrent myocardial infarction (MI) in three [7, 9, 11], target vascular revascularization(TVR) in two [9, 10], stent thrombosis in one [9], stroke in four [7, 9, 11, 12], and major adverse cardiovascular and cerebrovascular events (MACCE) in five [7, 10,11,12]
In this meta-analysis of ten randomized trials involving 1006 patients, we confirmed that Remote ischemic conditioning (RIC) conferred cardioprotection compared to primary PCI alone by reducing elevated myocardial enzyme and increasing the incidence of complete ST-segment resolution (cSTR) in patients after STEMI
Summary
Reperfusion to ischemic myocardium after ST segment elevation acute myocardial infarction (STEMI) can result in obvious myocardial ischemia/reperfusion (I/R) injury, which may impair the clinical benefit of primary percutaneous coronary intervention (PPCI) [1]. Remote ischemic conditioning (RIC) was first introduced by Przyklenk et al in 1993 [2]. By applying several cycles of transient ischemic stimulus in a remote organ (mostly a limb), RIC is known to protect the heart, kidney, and brain from reperfusion injury in various animal models[3]. RIC was shown to prevent reperfusion-induced endothelial dysfunction [4, 5], and offers novel, endogenous, noninvasive, and systemic protective potential [6].
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
