title: Meta-Analysis of Randomized Trials on Remote Ischemic Conditioning During Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction.
abstract: Ischemia/reperfusion injury adversely affects the final infarct size (IS) after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). Few studies have evaluated the role of remote ischemic conditioning (RIC) in reducing ischemia/reperfusion injury. However, the results of these studies were not consistent, and an overview of overall effectiveness of this technique in patients with STEMI is lacking. We conducted this meta-analysis to evaluate the available evidence in literature regarding the application of RIC in patients with STEMI who underwent primary PCI. The authors included randomized trials that studied RIC in patients with STEMI who underwent primary PCI versus no conditioning (standard of care). Final analysis included 8 trials with a total of 1,083 patients. Compared with standard of care alone, RIC was associated with reduced IS assessed by biomarker release (standardized mean difference = -0.23, 95% confidence interval [CI] -0.37 to -0.09; p = 0.001), better rates of ST-segment resolution (54% vs 30%; relative risk [RR] 1.78; 95% CI 1.35 to 2.34; p <0.001), reduced major adverse cardiac and cerebrovascular events (11% vs 20%; RR 0.57; 95% CI 0.39 to 0.83; p = 0.003), and nonsignificant reduction in IS assessed by cardiac imaging (standardized mean difference = -0.15; 95% CI -1.03 to -0.14; p = 0.36). There was no difference in postprocedural Thrombolysis In Myocardial Infarction-III flow between RIC and standard of care groups (86% vs 87%; RR 0.99; 95% CI 0.94 to 1.05; p = 0.81). In conclusion, remote ischemic conditioning may improve cardiovascular outcomes in patients with STEMI who underwent primary PCI evidenced by reduced biomarkers release, major adverse cardiac and cerebrovascular events, and better ST-segment resolution.
authors.affiliation: Department of Medicine, Rochester General Hospital, Rochester, New York; Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt. Electronic address: Ayman.Elbadawi@rochesterregional.org.
authors.forename: Ayman
authors.initials: A
authors.lastname: Elbadawi
authors.affiliation: Department of Medicine, Rochester General Hospital, Rochester, New York.
authors.forename: Le Dung
authors.initials: LD
authors.lastname: Ha
authors.affiliation: Division of Cardiovascular Medicine, Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Delaware, Newark.
authors.forename: Ahmed S
authors.initials: AS
authors.lastname: Abuzaid
authors.affiliation: SC Cardiologia, IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Crimi
authors.affiliation: Department of Cardiovascular diseases, Creighton University, Omaha, Nebraska.
authors.forename: Muhammad S
authors.initials: MS
authors.lastname: Azzouz
mesh_terms: D006801:Humans; D019157:Ischemic Preconditioning, Myocardial; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000628:therapy*; D016896:Treatment Outcome