improved ejection fraction following ischemic post-conditioning in
st-segment elevation myocardial infarction: a meta-analysis
2Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
3Sackler Faculty of Medicine, Tel Aviv University, Israel
4., Rabin Medical Center, Israel
5The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Israel
6Rappaport Faculty of Medicine and Research Institute, Technion - Israel Institute of Technology, Israel
7Department of Cardiology, Meir Medical Center, Israel
8Applicative Cardiovascular Research Center (ACRC), Meir Medical Center, Israel
Introduction: Early myocardial reperfusion therapy has been demonstrated as a strategy with a reduced morbidity and mortality amongst patients with ST-elevation myocardial infarction (STEMI). Yet, it may be associated with reperfusion-related myocardial injury in some patients. Ischemic postconditioning (IPoC) has been suggested as a technique to reduce consequent myocyte damage and other undesirable effects associated with reperfusion injury. However, conflicting results exist regarding the potential effect of IPoC on left ventricular ejection fraction (LVEF). To this end, an updated meta-analysis of randomized-controlled-trials (RCTs) comparing STEMI patients treated with conventional reperfusion therapy versus IPoC with stenting and its effect over LVEF was conducted.
Materials and Methods: Three databases were reviewed for RCTs conducted between January 1, 2000 until March 12, 2020. The effect of IPoC on LVEF for each study was estimated based upon mean LVEF and the standard deviation in each intervention and control group. Thereafter, random effects model meta-regression analysis was performed to estimate the pooled effect size (ES) based on the studies included.
Results and Discussion: Twelve studies were included in this meta-analysis, involving 369 IPoC patients and 334 controls. Estimated individual study effect sizes ranged between -0.11 and 1.83. Meta-regression revealed a moderate and significant positive effect for IPOC on LVEF (ES 0.67, 95% CI 0.34).
Conclusion: In patients with STEMI, reperfusion therapy using IPoC technique is significantly associated with improved LVEF compared with standard reperfusion practice. This beneficial effect supports the increased usage of IPoC in treating STEMI patients. Yet, it remains unknown if the observed pooled beneficial outcome is affected by patient characteristics, coronary instrumentation techniques and pharmacotherapies.
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