Key result
Ischemic postconditioning during primary PCI in STEMI patients did not improve the composite of HF, MI, and mortality compared to conventional PCI (RR 1.00; 95% CI 0.82-1.22; p=1).
Why the study?
Data comparing ischemic postconditioning during PCI with conventional PCI alone had yielded conflicting results.
Does ischemic postconditioning during primary PCI reduce the composite of heart failure, MI, and mortality in STEMI patients?
Meta-Analysis (n=2,566)
Does ischemic postconditioning during primary PCI reduce the composite of heart failure, MI, and mortality in STEMI patients?
Relative Risk: 1 (95% CI 0.82–1.22)
p-value: p=1
Ischemic postconditioning during primary PCI does not provide long-term clinical benefits over conventional primary PCI in patients with STEMI.
Postconditioning during primary PCI adds no long-term benefit in STEMI; confirms lack of efficacy and supports abandoning the strategy.
BACKGROUND: Data regarding ischemic postconditioning during percutaneous coronary intervention (PCI) as compared conventional PCI alone has yielded conflicting results. METHODS: Online databases comparing use of ischemic postconditioning percutaneous coronary intervention (ICP-PPCI) in STEMI patients with conventional PPCI were selected. Mortality, heart failure (HF), myocardial infarction (MI), and major adverse cardiac events (MACE) were evaluated. The primary outcome was composite of HF, MI, and mortality. Pooled risk ratio (RR) with 95% confidence interval (CI) were computed using random-effects model. RESULTS: Eight studies consisting of 2,566 patients (ICP-PPCI n = 1,228; PPCI n = 1,278) were included. The mean age for PPCI group was 61.38 ± 7.86 years (51% men) and for PCI 59.83 ± 8.94 years (47% men). There were no differences in outcome between ICP-PPCI and PPCI in terms of HF (RR 0.87 95% CI0.51-1.48; p = 0.29), MI (RR 1.28, 95%CI0.74-2.20; p = 0.20), mortality (RR 0.93, 95%CI0.64-1.34; p = 0.58), and MACE (RR 0.89, 95%CI0.74-1.07; p = 0.22). The results for composite event for the ICP-PPCI and PPIC procedures, at ≥1 year follow-up duration, were comparable (RR 1.00 95%CI0.82-1.22; p = 1). CONCLUSION: Ischemic postconditioning post percutaneous coronary intervention in STEMI patients has no long-term benefits over conventional PCI.
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Mir et al. (2021) conducted a meta-analysis in acute STEMI (n=2,566). Ischemic postconditioning percutaneous coronary intervention (ICP-PPCI) vs. Conventional primary PCI (PPCI) was evaluated on composite of HF, MI, and mortality (RR 1.00, 95% CI 0.82-1.22, p=1). Ischemic postconditioning during primary PCI in STEMI patients did not improve the composite of HF, MI, and mortality compared to conventional PCI (RR 1.00; 95% CI 0.82-1.22; p=1).
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