Remote Ischemic Perconditioning to Reduce Reperfusion Injury During Acute ST‐Segment–Elevation Myocardial Infarction: A Systematic Review and Meta‐Analysis

Abstract

BackgroundRemote ischemic conditioning (RIC) is a noninvasive therapeutic strategy that uses brief cycles of blood pressure cuff inflation and deflation to protect the myocardium against ischemia–reperfusion injury. The objective of this systematic review was to determine the impact of RIC on myocardial salvage index, infarct size, and major adverse cardiovascular events when initiated before catheterization.Methods and ResultsElectronic searches of Medline, Embase, and Cochrane Central Register of Controlled Trials were conducted and reference lists were hand searched. Randomized controlled trials comparing percutaneous coronary intervention (PCI) with and without RIC for patients with ST‐segment–elevation myocardial infarction were included. Two reviewers independently screened abstracts, assessed quality of the studies, and extracted data. Data were pooled using random‐effects models and reported as mean differences and relative risk with 95% confidence intervals. Eleven articles (9 randomized controlled trials) were included with a total of 1220 patients (RIC+PCI=643, PCI=577). Studies with no events were excluded from meta‐analysis. The myocardial salvage index was higher in the RIC+PCI group compared with the PCI group (mean difference: 0.08; 95% confidence interval, 0.02–0.14). Infarct size was reduced in the RIC+PCI group compared with the PCI group (mean difference: −2.46; 95% confidence interval, −4.66 to −0.26). Major adverse cardiovascular events were lower in the RIC+PCI group (9.5%) compared with the PCI group (17.0%; relative risk: 0.57; 95% confidence interval, 0.40–0.82).Conclusions RIC appears to be a promising adjunctive treatment to PCI for the prevention of reperfusion injury in patients with ST‐segment–elevation myocardial infarction; however, additional high‐quality research is required before a change in practice can be considered.

Cardiovascular events associated with nicorandil administration prior to primary percutaneous coronary intervention in patients with acute ST-segment elevated myocardial infarction: a systematic review and meta-analysis

“…These combined effects are expected to help promote myocardial recovery. Other possible approaches that have been evaluated to reduce reperfusion injury following PCI in patients with STEMI have included ischemic conditioning [48,49] and adenosine [50,51]: the results of these studies varied in terms of myocardial protection and survival benefits.…”

Impact of three methods of ischemic preconditioning on ischemia-reperfusion injury in a pig model of liver transplantation

“…After the advent of the experimental evidences of positive effects of IPC in I/R injury, several clinical studies started to show conflicting results about the real benefits of this procedure in medical practice. Recently, studies with a high level of evidence, as clinical trials, systematic reviews, and meta-analyses have demonstrated beneficial effects of direct or remote IPC in clinical situations involving myocardial 15,16 , renal 17 , and neuronal ischemia 18 . However, it is known that different tissue and organ sensitivities to ischemia are diverse so that such benefits cannot be generalized.…”

Review. Regional Networks in Acute Cardiac Care

“…[11][12][13] The recovery of myocardial tissue is the main goal of therapy in emergency settings and can be achieved by urgent revascularization. [14][15][16] In order to be effective, reperfusion of an occluded coronary artery should be achieved in the first 12 hours after the onset of chest pain. 17 While many precious hours are lost by the patients who do not present in time to the specialized services, sustained organizational efforts have been made in order to shorten the time from presentation to revascularization.…”