March 1, 2019BMJ OpenOpen Access

Effects of ischaemic postconditioning on outcomes of patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention: a meta-analysis

View Full Paper

Ask AI

Bookmark

Why the study?

The study was conducted to evaluate the effects of ischaemic postconditioning therapy on hard clinical endpoints in STEMI patients undergoing primary PCI.

Does ischaemic postconditioning combined with primary percutaneous coronary intervention reduce heart failure in patients with STEMI?

Structured PICO

Does ischaemic postconditioning combined with primary percutaneous coronary intervention reduce heart failure in patients with STEMI?

Population

3,137 patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PPCI) from 10 randomized trials

Intervention

Primary percutaneous coronary intervention (PPCI) combined with ischaemic postconditioning (IPC)

Comparator

Conventional primary percutaneous coronary intervention (PPCI)

Outcome

Heart failurehard clinical

Ischaemic postconditioning combined with primary PCI does not improve hard clinical outcomes such as heart failure, MACE, or all-cause mortality in patients with STEMI.

Implication

No reduction in HF, MACE or mortality with IPC after STEMI PPCI; challenges earlier surrogate benefits and supports standard reperfusion alone.

Abstract

OBJECTIVE: The aim of this meta-analysis was to evaluate the effects of ischaemic postconditioning (IPC) therapy on hard clinical endpoints in ST-segment elevation myocardial infarction (STEMI) patients who underwent primary percutaneous coronary intervention (PPCI). DESIGN: Systematic review and meta-analysis to evaluate the effects of IPC on the outcomes of patients with STEMI. DATA SOURCES: PubMed, Embase and the Cochrane Library were systematically searched for relevant articles published prior to May 1, 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised trials comparing conventional PPCI to PPCI combined with IPC in STEMI patients were included. The primary endpoint was heart failure. Secondary endpoints were all-cause mortality and major adverse cardiac events (MACE), including cardiac death, heart failure and MI. The Cochrane Reviewer's Handbook 4.2 was used to assess the risk of bias. DATA EXTRACTION AND SYNTHESIS: Relevant data were extracted by two independent investigators. We derived pooled risk ratios (RRs) with random effects models. Sensitivity and subgroup analyses were performed. RESULTS: Ten studies that had enrolled 3137 patients were included. PPCI combined with IPC failed to reduce heart failure (RR: 0.88, 95% CI: 0.61 to 1.26, p=0.47; absolute risk: 3.64% in the IPC group and 4.11% in the PPCI only group), all-cause mortality (RR: 0.94, 95% CI: 0.69 to 1.27, p=0.68; absolute risk: 5.07% in the IPC group and 5.27% in the PPCI onlygroup), MACE (RR: 1.05, 95% CI: 0.83 to 1.32, p=0.69; absolute risk: 9.37% in the IPC group and 8.93% in the PPCI only group), cardiac death (RR: 1.28, 95% CI: 0.85 to 1.93, p=0.24; absolute risk: 4.28% in the IPC group and 3.25% in the PPCI only group) and MI (RR: 1.08, 95% CI: 0.38 to 3.12, p=0.88; absolute risk: 3.61% in the IPC group and 3.44% in the PPCI only group). CONCLUSIONS: IPC combined with PPCI does not reduce heart failure, MACE and all-cause mortality compared with traditional PPCI in patients with STEMI. TRIAL REGISTRATION NUMBER: CRD42017063959.