Effect of ischemic post-conditioning on myocardial injury in ST-elevation myocardial infarction: a meta-analysis
2Rabin Medical Center, Petah Tikva, Israel
3The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Israel
4Rappaport Faculty of Medicine and Research Institute, Technion - Israel Institute of Technology, Israel
5Soroka University Medical Center, Ben-Gurion University of the Negev, Israel
6Department of Cardiology, Meir Medical Center, Israel
7Applicative Cardiovascular Research Center (ACRC), Meir Medical Center, Israel
Introduction:
Ischemic post-conditioning (IPoC) was developed in an attempt to minimize reperfusion related myocardial injury. Some studies have suggested that cardiac biomarkers, which are surrogates for myocardial injury, are lower following IPoC in the setting of ST-elevation myocardial-infarction (STEMI). Still, whether IPoC confers a cardioprotective effect remains controversial. To test this hypothesis, a meta-analysis of all methodologically adequate studies involving creatine kinase (CK) and its CK-MB cardiac isoform was performed. Unfortunately, there were not enough relevant studies reporting on cardiac-troponin.
Methods:
Electronic databases were searched for randomized- trials comparing the effects of IPoC during percutaneous-coronary-intervention (PCI) versus standard of practice in patients suffering from STEMI.
The primary investigated outcomes were peak-CK and peak-CK-MB. Effect size (ES) was estimated based upon mean values and the standard deviation in each study group, using a meta-regression analysis model.
Results and Discussion:
4079 articles were identified through database searching, with 2021 remaining after removal of duplicates. These records were then screened, resulting in 58 full text articles. After in-depth assessment for eligibility, eleven studies (1273 patients) reporting on CK-MB and eight studies (505 patients) reporting on CK were included. Estimated individual study ES of IPoC on peak CK-MB ranged between -3.22 and 2.32. Meta-regression revealed an insignificant effect of IPoC on peak CK-MB (ES -0.41, 95% CI -1.15 to 0.34). Also, estimated individual study effect sizes of IPoC on peak CK ranged between -2.38 and 1.79. Meta-regression revealed an insignificant effect of IPoC on peak CK (ES -0.42, 95% CI -1.20 to 0.36).
Conclusion:
IPoC does not appear to reduce short-term myocardial injury as reflected by CK and CK-MB in patients with STEMI undergoing primary PCI. It remains unknown if the results would have been different had other biomarkers been reported on. Whether specific patient characteristics confer a selective beneficial effect merits further study.
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