title: Ischaemic postconditioning reduces infarct size: systematic review and meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Infarct size (IS) is a major determinant of patient outcome after acute ST-segment elevation myocardial infarction (STEMI). Interventions aimed at reducing reperfusion injury, such as cardiac ischaemic postconditioning (IPost), may reduce IS and improve clinical outcomes. IPost has been shown to be feasible in patients with STEMI treated by primary percutaneous coronary intervention (PPCI).
  
  
  OBJECTIVE
  To provide an updated summary of the efficacy of IPost, assessed by analysing accurate surrogate markers of IS.
  
  
  METHODS
  We performed a meta-analysis of randomized controlled trials that evaluated the efficacy of IPost in STEMI patients undergoing PPCI. The main outcome was area under the curve of serum creatine kinase release (CK-AUC). Secondary outcomes were other surrogate biomarkers of IS, complete ST-segment resolution, direct measurement of IS by single-photon emission computed tomography and estimation of IS by cardiac magnetic resonance (CMR-IS).
  
  
  RESULTS
  Eleven studies were retrieved, including 1313 STEMI patients undergoing PPCI with or without IPost. Compared with controls, we observed a significant reduction in CK-AUC (standard mean difference [SMD] -2.84 IU/L, 95% CI -5.43 to -0.25 IU/L; P=0.03). Other surrogate markers, such as CMR-IS (SMD -0.36, 95% CI -0.88 to 0.15; P=0.16), showed a non-significant IS reduction in the IPost group.
  
  
  CONCLUSIONS
  This meta-analysis, dealing with accurate surrogate markers of IS, suggests that IPost reduces IS. However, results should be interpreted cautiously because of limited sample sizes and significant heterogeneity. Whether this translates into improvements in cardiac function and patient prognosis still needs to be demonstrated in larger prospective randomized controlled studies that are powered sufficiently.
authors.affiliation: CHRU de Tours, ICCU & Cardiology department, Trousseau Hospital, 37000 Tours, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Touboul
authors.affiliation: CHRU de Tours, ICCU & Cardiology department, Trousseau Hospital, 37000 Tours, France; Université François Rabelais, EA 4245 Cellules Dendritiques Immunomodulation et Greffes, FHU "SUPORT", 37000 Tours, France. Electronic address: d.angoulvant@chu-tours.fr.
authors.forename: Denis
authors.initials: D
authors.lastname: Angoulvant
authors.affiliation: Inserm U1060-CarMeN, service d'explorations fonctionnelles cardiovasculaires, centre d'investigation clinique, 1407, université Claude-Bernard Lyon 1, Louis-Pradel Hospital, CHU de Lyon, Lyon, France.
authors.forename: Nathan
authors.initials: N
authors.lastname: Mewton
authors.affiliation: CHRU de Tours, ICCU & Cardiology department, Trousseau Hospital, 37000 Tours, France; Université François Rabelais, EA 4245 Cellules Dendritiques Immunomodulation et Greffes, FHU "SUPORT", 37000 Tours, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Ivanes
authors.affiliation: Department of Pathophysiology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
authors.forename: Danina
authors.initials: D
authors.lastname: Muntean
authors.affiliation: EA 3860 cardioprotection remodelage et thrombose, Cardiology Department, université d'Angers, CHU d'Angers, Angers, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Prunier
authors.affiliation: Inserm U1060-CarMeN, service d'explorations fonctionnelles cardiovasculaires, centre d'investigation clinique, 1407, université Claude-Bernard Lyon 1, Louis-Pradel Hospital, CHU de Lyon, Lyon, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Ovize
authors.affiliation: CHRU de Tours, department of Pharmacology, Tours, France; CNRS UMR 7292, Tours, France; Université François Rabelais, GICC, Tours, France.
authors.forename: Theodora
authors.initials: T
authors.lastname: Bejan-Angoulvant
mesh_terms: D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003402:Creatine Kinase / Q000097:blood; D006801:Humans; D057775:Ischemic Postconditioning; D008279:Magnetic Resonance Imaging; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D009206:Myocardium / Q000473:pathology; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D015427:Reperfusion Injury / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D003402:Creatine Kinase
keywords: Essai thérapeutique contrôlé randomisé; Infarct size reduction; Ischaemic postconditioning; Meta-analysis; Méta-analyse; Postconditionnement ischémique; Randomized controlled trials; Réduction de taille d’infarctus