Meta-Analysis of Randomized Trials on Remote Ischemic Conditioning During Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction

doi:10.1016/j.amjcard.2016.11.036

The American Journal of Cardiology

Volume 119, Issue 6, 15 March 2017, Pages 832-838

https://doi.org/10.1016/j.amjcard.2016.11.036 Get rights and content

Ischemia/reperfusion injury adversely affects the final infarct size (IS) after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). Few studies have evaluated the role of remote ischemic conditioning (RIC) in reducing ischemia/reperfusion injury. However, the results of these studies were not consistent, and an overview of overall effectiveness of this technique in patients with STEMI is lacking. We conducted this meta-analysis to evaluate the available evidence in literature regarding the application of RIC in patients with STEMI who underwent primary PCI. The authors included randomized trials that studied RIC in patients with STEMI who underwent primary PCI versus no conditioning (standard of care). Final analysis included 8 trials with a total of 1,083 patients. Compared with standard of care alone, RIC was associated with reduced IS assessed by biomarker release (standardized mean difference = −0.23, 95% confidence interval [CI] −0.37 to −0.09; p = 0.001), better rates of ST-segment resolution (54% vs 30%; relative risk [RR] 1.78; 95% CI 1.35 to 2.34; p <0.001), reduced major adverse cardiac and cerebrovascular events (11% vs 20%; RR 0.57; 95% CI 0.39 to 0.83; p = 0.003), and nonsignificant reduction in IS assessed by cardiac imaging (standardized mean difference = −0.15; 95% CI −1.03 to −0.14; p = 0.36). There was no difference in postprocedural Thrombolysis In Myocardial Infarction-III flow between RIC and standard of care groups (86% vs 87%; RR 0.99; 95% CI 0.94 to 1.05; p = 0.81). In conclusion, remote ischemic conditioning may improve cardiovascular outcomes in patients with STEMI who underwent primary PCI evidenced by reduced biomarkers release, major adverse cardiac and cerebrovascular events, and better ST-segment resolution.

Section snippets

Methods

We performed a computerized search of the Medline, Cochrane, and Web of Science databases without language restrictions up to September 2016, using the search terms “remote conditioning” or “remote preconditioning” or “remote postconditioning” or “remote perconditioning” or “remote ischemic conditioning” or “remote ischemic preconditioning” or “remote ischemic postconditioning” or “remote ischemic perconditioning” in patients with myocardial infarction. Abstracts of the major scientific

Results

Study selection process is described in the flow diagram (Figure 1). Eight studies met our inclusion criteria including a total of 1,083 patients. Seven studies were retrieved from Medline database,3, 4, 5, 20, 21, 22, 23 and one study was presented as an abstract at Society for Cardiac Angiography and Interventions meeting in 2016.²⁴ Data from Boetker et al³ were retrieved from the initial published article and subsequent article reporting 3-year follow-up results of the same study

Discussion

In this meta-analysis of 8 randomized trials including 1,083 patients with STEMI who underwent primary PCI, RIC was associated with reduced IS assessed by biomarker release compared with standard of care. RIC was also associated with better achievement of full STR and lower MACCE rates. There was a nonsignificant reduction in IS assessed by cardiac imaging and no difference in postprocedural TIMI-III flow with RIC technique. Meta-regression analysis showed that increasing the duration of

Disclosures

The authors have no conflicts of interest to disclose.

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Coronary Artery DiseaseMeta-Analysis of Randomized Trials on Remote Ischemic Conditioning During Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction

Section snippets

Methods

Results

Discussion

Disclosures

Lancet

JACC Cardiovasc Interv

Am Heart J

Int J Cardiol

JACC Cardiovasc Interv

JACC Cardiovasc Interv

Am J Cardiol

9th Hatter Biannual Meeting: position document on ischaemia/reperfusion injury, conditioning and the ten commandments of cardioprotection

Basic Res Cardiol

Regional ischemic ‘preconditioning’ protects remote virgin myocardium from subsequent sustained coronary occlusion

Circulation

Remote ischemic conditioning and cardioprotection: a systematic review and meta-analysis of randomized clinical trials

Basic Res Cardiol

Cardiac remote ischaemic preconditioning reduces periprocedural myocardial infarction for patients undergoing percutaneous coronary interventions: a meta-analysis of randomised clinical trials

EuroIntervention

Remote ischemic conditioning to protect against ischemia-reperfusion injury: a systematic review and meta-analysis

PLoS One

Remote ischemic conditioning in percutaneous coronary intervention and coronary artery bypass grafting

Circ J

Ischemic conditioning as an adjunct to percutaneous coronary intervention

Circ Cardiovasc Interventions

Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine

Coronary Artery Disease
Meta-Analysis of Randomized Trials on Remote Ischemic Conditioning During Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction