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Ischemic Postconditioning Confers No Benefit to Left Ventricular Systolic Function: A Meta-Analysis of Cardiac
Idan Bergman1, Dennis Boyle2, Omri Braver3
1Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Rabin Medical Center, Petach Tikva, Israel.
Insights
Ischemic postconditioning (IPoC) does not improve left ventricular ejection fraction (LVEF) in acute ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention. This meta-analysis found no significant benefit of IPoC on cardiac function.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Imaging
Background:
- Ischemic postconditioning (IPoC) is a strategy to mitigate reperfusion injury in acute ST-elevation myocardial infarction (STEMI).
- Its clinical efficacy, particularly when combined with percutaneous coronary intervention (PCI), remains controversial.
- Left ventricular ejection fraction (LVEF) assessed by cardiac magnetic resonance imaging (CMR) is a key indicator of myocardial recovery.
Conclusions:
- IPoC, as an adjunct to PCI in acute STEMI patients with minimal initial coronary flow, does not enhance left ventricular systolic function.
- Current evidence suggests IPoC provides no discernible benefit for LVEF recovery as measured by CMR.
- Further research may be needed to explore potential niche applications or alternative endpoints for IPoC.
Abstract:
Ischemic postconditioning (IPoC) is a technique suggested to reduce reperfusion injury in patients suffering acute ST-elevation myocardial infarction (STEMI), although its use is highly controversial. This meta-analysis aimed to evaluate the effect of IPoC with percutaneous coronary intervention in patients with acute STEMI, as measured by follow-up left ventricular ejection fraction (LVEF) on cardiac magnetic resonance imaging. The investigators searched PubMed, Embase, and Web of Science for all randomized controlled trials published during the last 2 decades. After the removal of duplicates, 2,021 articles from online databases had been identified using relevant search criteria. The included randomized controlled trials had studied patients with acute STEMI and Thrombolysis in Myocardial Infarction flow 0 to 1 at presentation and had measured follow-up LVEF using cardiac magnetic resonance imaging. Overall, 11 studies (n = 1,339 patients) qualified for inclusion. In each study, the control group did not differ significantly from the experimental group. The pooled data from included studies were analyzed using standardized mean difference between IPoC and control groups, and the 95% confidence interval for LVEF; the results were visualized using a forest plot. Bivariate regression analyses and 1-way analyses of LVEF coefficient ratios were done to isolate for various clinical and procedural parameters. An analysis of pooled data of the IPoC (n = 674) and control (n = 665) groups showed that IPoC did not significantly impact follow-up LVEF (using standardized mean difference 0.10, 95% confidence interval 0.00 to 0.21). Further analysis showed that IPoC did not improve follow-up LVEF when isolating for relevant clinical and procedural parameters. In conclusion, the use of IPoC as an adjunctive therapy to percutaneous coronary intervention seemingly provides no benefit to left ventricular systolic function, as quantified with cardiac magnetic resonance imaging, in patients with acute STEMI with Thrombolysis in Myocardial Infarction flow 0 to 1.
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