title: Surrogate and clinical outcomes following ischemic postconditioning during primary percutaneous coronary intervention of ST--segment elevation myocardial infarction: a meta-analysis of 15 randomized trials.
abstract: OBJECTIVE
  To conduct a meta-analysis on surrogate and clinical outcomes with myocardial ischemic postconditioning (IPoC) following revascularization with primary percutaneous intervention (PPCI) for ST-segment myocardial infarction (STEMI) compared with PPCI alone.
  
  
  BACKGROUND
  Reperfusion injury remains an important problem following PPCI for STEMI. Trials of IPoC have mainly focused on cardiac biomarkers; the impact on clinical outcomes is unknown.
  
  
  METHODS
  Clinical trials that randomized STEMI patients to IPoC as compared with conventional PPCI were included for analysis.
  
  
  RESULTS
  A total of 15 randomized trials with 1,545 patients met our selection criteria (785 underwent IPoC + PPCI, 760 PPCI alone). Mean follow-up for clinical outcomes was 4.7 months. The mean ischemic time was 225 min. ST-segment resolution (Relative Risk [RR] = 0.98; 95% Confidence Intervals [CI] 0.85-1.13; P = 0.75) and infarct size (Weighted mean difference [WMD] = -2.53%, 95% CI -6.10 to 1.05; P = 0.17) were similar between the IPoC + PPCI vs. PPCI arms. Left ventricular ejection fraction at follow-up was marginally higher in the IPoC (WMD = 4.15%, 95% CI 0.19-8.12%, P = 0.04). No differences were noted in any of the clinical outcomes studied, including mortality (RR = 1.52; 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 = 0.83) or the composite MACE outcome (RR = 1.53; 95% CI 0.89-2.63; P = 0.13).
  
  
  CONCLUSIONS
  IPoC following PPCI is not associated with improvements in surrogate or clinical outcomes at 5 months as compared with PPCI alone. Our findings indicate no role for IPoC in the routine management of patients with STEMI.
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Houman
authors.initials: H
authors.lastname: Khalili
authors.forename: Vishal G
authors.initials: VG
authors.lastname: Patel
authors.forename: Helen G
authors.initials: HG
authors.lastname: Mayo
authors.forename: James A
authors.initials: JA
authors.lastname: de Lemos
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Bavry
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.forename: Dharam J
authors.initials: DJ
authors.lastname: Kumbhani
mesh_terms: D006801:Humans; D057775:Ischemic Postconditioning / Q000009:adverse effects / Q000401:mortality; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015428:Myocardial Reperfusion Injury / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: ischemic conditioning; meta-analysis; mortality; myocardial infarction; outcome