Remote Ischemic Conditioning in Patients with Acute Coronary Syndromes: A Systematic Review with Meta-Analysis and...

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Trials

Background:

• Acute coronary syndromes (ACS) represent a significant cause of morbidity and mortality.
• Percutaneous coronary intervention (PCI) is a primary treatment for ACS.
• Remote ischemic conditioning (RIC) is a potential cardioprotective strategy.

Purpose of the Study:

• To evaluate the efficacy of remote ischemic conditioning (RIC) compared to no conditioning.
• To assess the impact of RIC on clinical endpoints in patients with ACS undergoing PCI.

Main Methods:

• Systematic review and meta-analysis of 13 randomized clinical trials (RCTs) including 7183 patients.
• Literature search up to September 13, 2019.
• Analysis of endpoint mortality, myocardial infarction (MI), and congestive heart failure (CHF) using rate ratios (RR) and confidence intervals (CI).
• Evaluation of small-study effects and risk of false-positive results using trim-and-fill and trial sequential analysis (TSA).

Main Results:

• RIC did not significantly reduce endpoint mortality (RR=0.81, 95% CI: 0.56-1.17) or myocardial infarction (RR=0.85, 95% CI: 0.62-1.18).
• No significant effect was observed for congestive heart failure (RR=0.71, 95% CI: 0.44-1.15).
• Controlling for small-study effects confirmed the lack of efficacy for RIC.

Conclusions:

• Current evidence from this systematic review indicates that RIC offers no significant benefit for clinical endpoints in ACS patients undergoing PCI.
• RIC did not demonstrate efficacy in reducing mortality, MI, or CHF during a median 1-year follow-up.