title: Cardioprotective role of ischemic postconditioning in acute myocardial infarction: a systematic review and meta-analysis.
abstract: BACKGROUND
  Evidence suggests that ischemic postconditioning (IPoC) may reduce the extent of reperfusion injury. We performed a meta-analysis of randomized controlled trials, which compared the role of IPoC during primary percutaneous coronary intervention (PCI) to PCI alone (control group) in ST-segment elevation myocardial infarction.
  
  
  METHODS
  Several databases were searched, which yielded 19 studies. The outcomes of interest were measures of myocardial damage (serum cardiac enzymes and infarct size by imaging) and left ventricular function (left ventricular ejection fraction and wall motion score index). Mean difference (MD) and standardized mean difference (SMD) were used to assess the treatment effect. An inverse variance method was used to pool data into a random-effects model.
  
  
  RESULTS
  Ischemic postconditioning demonstrated a decrease in serum cardiac enzymes (SMD -0.48, 95% CI -0.92 to -0.05, I(2) = 92%), reduction in infarct size by imaging (SMD -0.30, 95% CI -0.58 to -0.01, I(2) = 80%), wall motion score index (MD -0.19, 95% CI -0.29 to -0.09, I(2) = 44%), and showed improvement in left ventricular ejection fraction (IPoC 52 ± 0.4, control 49.7 ± 0.4) (MD 2.78, 95% CI 0.66-4.91, I(2) = 69%). All included studies were limited by high risk of performance and publication bias.
  
  
  CONCLUSIONS
  Ischemic postconditioning during PCI in ST-segment elevation myocardial infarction appears to be superior to PCI alone in reduction of both myocardial injury or damage and improvement in global and regional left ventricular function. The effect seems to be more pronounced when a greater myocardial area is at risk. Given the limitations of the current available evidence, additional data from large randomized controlled trials are warranted.
authors.affiliation: Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH.
authors.forename: Abdur Rahman
authors.initials: AR
authors.lastname: Khan
authors.affiliation: Department of Internal Medicine, University of Missouri - Kansas City, Kansas, MO.
authors.forename: Aref A
authors.initials: AA
authors.lastname: Binabdulhak
authors.affiliation: Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH.
authors.forename: Yaseen
authors.initials: Y
authors.lastname: Alastal
authors.affiliation: Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH.
authors.forename: Sobia
authors.initials: S
authors.lastname: Khan
authors.affiliation: Mulford Health Science Library - University of Toledo, Toledo, OH.
authors.forename: Bridget M
authors.initials: BM
authors.lastname: Faricy-Beredo
authors.affiliation: Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH.
authors.forename: Faraz Khan
authors.initials: FK
authors.lastname: Luni
authors.affiliation: Mulford Health Science Library - University of Toledo, Toledo, OH.
authors.forename: Wade M
authors.initials: WM
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH.
authors.forename: Sadik
authors.initials: S
authors.lastname: Khuder
authors.affiliation: Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH. Electronic address: jodi.tinkel@utoledo.edu.
authors.forename: Jodi
authors.initials: J
authors.lastname: Tinkel
mesh_terms: D004562:Electrocardiography; D006801:Humans; D057775:Ischemic Postconditioning / Q000379:methods*; D009203:Myocardial Infarction / Q000628:therapy*; D016896:Treatment Outcome