A systematic review and meta-analysis evaluating ischemic conditioning during percutaneous coronary intervention

Area of Science:

• Cardiology
• Interventional Cardiology
• Ischemic Conditioning

Background:

• Percutaneous coronary intervention (PCI) is a common procedure for coronary artery disease.
• Ischemic conditioning, a protective phenomenon against ischemia-reperfusion injury, is being explored to improve PCI outcomes.
• Remote ischemic preconditioning (RIPreC) and local ischemic postconditioning (LIPostC) are two such strategies.

Purpose of the Study:

• To systematically review and meta-analyze the efficacy of ischemic conditioning during PCI.
• To evaluate the impact of RIPreC and LIPostC on key cardiac outcomes.

Main Methods:

• A systematic review and meta-analysis of randomized controlled trials.
• Searched databases for studies on ischemic conditioning in PCI.
• Created subgroups to analyze mortality, myocardial salvage index, and infarct size.

Main Results:

• RIPreC did not show a significant difference in mortality for elective PCI (OR: 0.34; 95% CI: 0.08-1.56).
• RIPreC favored improved myocardial salvage index in ST-elevation myocardial infarction (STEMI) (MD: 0.13; 95% CI: 0.07-0.19).
• LIPostC favored reduced infarct size in STEMI (MD: -4.13 g·m⁻²; 95% CI: -7.36 to -0.90 g·m⁻²).

Conclusions:

• RIPreC and LIPostC demonstrate potential benefits in myocardial salvage and infarct size reduction for STEMI patients undergoing PCI.
• No mortality benefit was observed with RIPreC in the context of elective PCI.