Abstract 17500: Surrogate and Clinical Outcomes Following Ischemic Postconditioning During Primary Percutaneous Coronary Intervention of ST-segment Elevation Myocardial Infarction: A Meta-analysis of 17 Randomized Trials
Background: Myocardial ischemic postconditioning (IPoC) is a strategy to reduce reperfusion injury in STEMI that involves intermittent cycles of coronary blood flow interruption following primary PCI (PPCI). Trials of IPoC have mainly focused on cardiac biomarkers. This study sought to determine if IPoC + PPCI improves surrogate and clinical outcomes compared with PPCI alone.
Methods: Clinical trials that randomized STEMI patients to IPoC + PPCI compared with conventional PPCI were included for analysis.
Results: There were 17 randomized trials with 1,607 patients that met our selection criteria (819 underwent IPoC + PPCI, 788 PPCI alone) (mean follow-up: 5 months). The target vessel was LAD in 53.2% and RCA in 30.7%; mean ischemic time was 225 min. The most common protocol for IPoC was 3 balloon inflations at 4-6 atmospheres X 60 sec, separated by 60 sec. ST- resolution was similar between the IPoC + PPCI and PPCI arms (Risk Ratio [RR] = 1.02; 95% CI 0.89-1.18; p=0.75). Infarct size (Weighted mean difference [WMD] = -2.36%, 95% CI -6.98 to 2.26; p=0.32) and LV ejection fraction (WMD = 4.2%, 95% CI -0.02% to 8.53%, p=0.051) were similar as well. No differences were noted in any of the clinical outcomes studied, including mortality (RR = 1.15; 95% CI 0.77 - 2.99; p=0.23), recurrent MI (RR = 3.04; 95% CI 0.74 - 12.54; p=0.12), stent thrombosis (RR = 1.24, 95% CI 0.51 -3.04; p=0.63) or the composite MACE outcome (RR = 1.53; 95% CI 0.89 - 2.63; p=0.13) (Figure).
Conclusions: IPoC during PPCI is not associated with improvements in surrogate and clinical outcomes as compared with PPCI alone. Barring any further studies, our findings indicate no role for IPoC in the current management of patients with STEMI undergoing PPCI.
- © 2013 by American Heart Association, Inc.