Caroline Touboul1, Denis Angoulvant2, Nathan Mewton3, Fabrice Ivanes4, Danina Muntean5, Fabrice Prunier6, Michel Ovize3, Theodora Bejan-Angoulvant7. 1. CHRU de Tours, ICCU & Cardiology department, Trousseau Hospital, 37000 Tours, France. 2. CHRU de Tours, ICCU & Cardiology department, Trousseau Hospital, 37000 Tours, France; Université François Rabelais, EA 4245 Cellules Dendritiques Immunomodulation et Greffes, FHU "SUPORT", 37000 Tours, France. Electronic address: d.angoulvant@chu-tours.fr. 3. Inserm U1060-CarMeN, service d'explorations fonctionnelles cardiovasculaires, centre d'investigation clinique, 1407, université Claude-Bernard Lyon 1, Louis-Pradel Hospital, CHU de Lyon, Lyon, France. 4. CHRU de Tours, ICCU & Cardiology department, Trousseau Hospital, 37000 Tours, France; Université François Rabelais, EA 4245 Cellules Dendritiques Immunomodulation et Greffes, FHU "SUPORT", 37000 Tours, France. 5. Department of Pathophysiology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania. 6. EA 3860 cardioprotection remodelage et thrombose, Cardiology Department, université d'Angers, CHU d'Angers, Angers, France. 7. CHRU de Tours, department of Pharmacology, Tours, France; CNRS UMR 7292, Tours, France; Université François Rabelais, GICC, Tours, France.
Abstract
BACKGROUND: Infarct size (IS) is a major determinant of patient outcome after acute ST-segment elevation myocardial infarction (STEMI). Interventions aimed at reducing reperfusion injury, such as cardiac ischaemic postconditioning (IPost), may reduce IS and improve clinical outcomes. IPost has been shown to be feasible in patients with STEMI treated by primary percutaneous coronary intervention (PPCI). AIMS: To provide an updated summary of the efficacy of IPost, assessed by analysing accurate surrogate markers of IS. METHODS: We performed a meta-analysis of randomized controlled trials that evaluated the efficacy of IPost in STEMI patients undergoing PPCI. The main outcome was area under the curve of serum creatine kinase release (CK-AUC). Secondary outcomes were other surrogate biomarkers of IS, complete ST-segment resolution, direct measurement of IS by single-photon emission computed tomography and estimation of IS by cardiac magnetic resonance (CMR-IS). RESULTS: Eleven studies were retrieved, including 1313 STEMI patients undergoing PPCI with or without IPost. Compared with controls, we observed a significant reduction in CK-AUC (standard mean difference [SMD] -2.84 IU/L, 95% CI -5.43 to -0.25 IU/L; P=0.03). Other surrogate markers, such as CMR-IS (SMD -0.36, 95% CI -0.88 to 0.15; P=0.16), showed a non-significant IS reduction in the IPost group. CONCLUSIONS: This meta-analysis, dealing with accurate surrogate markers of IS, suggests that IPost reduces IS. However, results should be interpreted cautiously because of limited sample sizes and significant heterogeneity. Whether this translates into improvements in cardiac function and patient prognosis still needs to be demonstrated in larger prospective randomized controlled studies that are powered sufficiently.
BACKGROUND:Infarct size (IS) is a major determinant of patient outcome after acute ST-segment elevation myocardial infarction (STEMI). Interventions aimed at reducing reperfusion injury, such as cardiac ischaemic postconditioning (IPost), may reduce IS and improve clinical outcomes. IPost has been shown to be feasible in patients with STEMI treated by primary percutaneous coronary intervention (PPCI). AIMS: To provide an updated summary of the efficacy of IPost, assessed by analysing accurate surrogate markers of IS. METHODS: We performed a meta-analysis of randomized controlled trials that evaluated the efficacy of IPost in STEMI patients undergoing PPCI. The main outcome was area under the curve of serum creatine kinase release (CK-AUC). Secondary outcomes were other surrogate biomarkers of IS, complete ST-segment resolution, direct measurement of IS by single-photon emission computed tomography and estimation of IS by cardiac magnetic resonance (CMR-IS). RESULTS: Eleven studies were retrieved, including 1313 STEMI patients undergoing PPCI with or without IPost. Compared with controls, we observed a significant reduction in CK-AUC (standard mean difference [SMD] -2.84 IU/L, 95% CI -5.43 to -0.25 IU/L; P=0.03). Other surrogate markers, such as CMR-IS (SMD -0.36, 95% CI -0.88 to 0.15; P=0.16), showed a non-significant IS reduction in the IPost group. CONCLUSIONS: This meta-analysis, dealing with accurate surrogate markers of IS, suggests that IPost reduces IS. However, results should be interpreted cautiously because of limited sample sizes and significant heterogeneity. Whether this translates into improvements in cardiac function and patient prognosis still needs to be demonstrated in larger prospective randomized controlled studies that are powered sufficiently.
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