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Updated: Apr 26, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Meta-analysis of randomized trials of postconditioning in ST-elevation myocardial infarction
Enrico Favaretto1, Marco Roffi2, Anna C Frigo1
1Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy.
Insights
Postconditioning may reduce infarct size in ST-elevation myocardial infarction (STEMI) patients. However, this benefit disappears when using more accurate cardiac magnetic resonance imaging, suggesting more research is needed for clinical practice.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- The clinical benefit of postconditioning in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention remains debated.
- Existing randomized clinical trials (RCTs) provide conflicting evidence on its efficacy.
Purpose of the Study:
- To conduct a meta-analysis of available RCTs to clarify the role of postconditioning in STEMI patients.
- To evaluate the cardioprotective effects of postconditioning, specifically focusing on infarct size reduction.
Main Methods:
- A meta-analysis was performed on 14 RCTs involving 778 STEMI patients, identified from major biomedical databases (PubMed, EMBase, Cochrane).
- Data were analyzed from January 1998 to February 2014.
- Meta-regression was used to explore heterogeneity and identify factors influencing postconditioning effects.
Main Results:
- Overall, postconditioning demonstrated a statistically significant reduction in infarct size (weighted standardized mean difference -0.5837, p <0.05).
- Significant heterogeneity (I² = 84%) was observed across the included trials.
- When analysis was restricted to trials using cardiac magnetic resonance (CMR) for infarct size assessment (6 RCTs, 448 patients), the cardioprotective benefit of postconditioning was no longer significant.
Conclusions:
- The meta-analysis suggests postconditioning may reduce infarct size in STEMI patients.
- However, the observed benefit is lost when employing more precise methods like CMR for infarct size quantification.
- Further research and data are necessary before widespread adoption of postconditioning in clinical practice can be recommended.
Abstract:
Clinical benefit of postconditioning in patients with ST-elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention is still controversial. We performed a meta-analysis of available randomized clinical trials (RCTs) to define the role of postconditioning in STEMI. Fourteen RCTs evaluating postconditioning in a total of 778 patients with STEMI were identified in PubMed, EMBase, and Cochrane databases from January 1998 to February 2014. Overall, postconditioning was found to be cardioprotective in term of infarct size reduction (weighted standardized mean differences -0.5837, 95% confidence interval -0.9609 to -0.2066, p <0.05), but significant heterogeneity across the trials was detected (I(2) = 84%). Univariate meta-regression analysis did not identify clinical or procedural variables associated with a more pronounced effect of postconditioning effects on infarct size with the exception of using cardiac magnetic resonance (CMR) to evaluate infarct size (p <0.01). Restricting the analysis to 6 RCTs including a total of 448 patients and evaluating the postconditioning effect on infarct size by means of CMR led to the disappearance of benefit of postconditioning on infarct size. In conclusion, the results of this meta-analysis of RCTs suggested that postconditioning reduces infarct size, as expressed by weighted standardized mean differences. However, if the analysis was limited to trials with a more accurate quantification of infarct size reduction, namely by CMR, the benefit was lost. More data are required before adoption of postconditioning in clinical practice.
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