title: Meta-analysis of randomized trials of postconditioning in ST-elevation myocardial infarction.
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.
authors.affiliation: Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Favaretto
authors.affiliation: Division of Cardiology, University Hospital, Geneva, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Roffi
authors.affiliation: Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Frigo
authors.affiliation: Division of Cardiology, UCLA Medical Center, Los Angeles, California.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lee
authors.affiliation: Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Martina P
authors.initials: MP
authors.lastname: Marra
authors.affiliation: Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Napodano
authors.affiliation: Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy. Electronic address: giuseppe.tarantini.1@unipd.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
mesh_terms: D002316:Cardiotonic Agents / Q000627:therapeutic use*; D004562:Electrocardiography; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D062645:Percutaneous Coronary Intervention; D011182:Postoperative Care / Q000379:methods*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic
chemical_list: D002316:Cardiotonic Agents