Clinical InvestigationAcute Ischemic Heart DiseaseCardioprotective role of ischemic postconditioning in acute myocardial infarction: A systematic review and meta-analysis
Section snippets
Data sources and search strategy
The systematic review was carried out in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.31 The search strategy and subsequent literature search was performed by experienced medical reference librarians (B.F., W.L.). The search strategies were developed in PubMed and translated to match the subject headings and keywords for Embase, Cochrane Central Register of Controlled Trials, ISI Web of Science, and Scopus from last 10 years through
Identification of studies
The literature search identified 506 publications, of which 19 studies were eligible for analysis (Figure 1).8, 9, 10, 11, 12, 13, 14, 16, 17, 18, 19, 23, 24, 25, 27, 28, 29, 30 Articles reporting outcomes from the same study were included once in the analysis.9, 10, 14, 15 There was excellent agreement for the inclusion of the studies, data abstraction, and quality assessment between the reviewers.
Study characteristics
Table summarizes the characteristics of the included studies. A total of 19 studies comprising
Discussion
In our meta-analysis, we found that IPoC showed a beneficial effect in reduction of myocardial injury or damage and improvement of left ventricular function when compared with PCI alone. This cardioprotection was more apparent when the IRA was predominantly LAD as compared with non-LAD. Our results suggest that myocardial salvage is better in the anterior location compared with the inferior location because of a greater myocardial area being at risk. The lack of substantial effect of IPoC in
Conclusions
Ischemic postconditioning during PCI in STEMI 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 secondary to LAD involvement. Given the limitations of the current available evidence, additional data from large RCTs are warranted.
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Cited by (34)
Redox signaling in ischemic postconditioning protection involves PKCε and Erk1/2 pathways and converges indirectly in Nrf2 activation
2019, Cellular SignallingCitation Excerpt :Ischemic postconditioning (iPostC) is a cardioprotective maneuver in which short cycles of ischemia/reperfusion (IR), are applied in the coronary artery before prolonged reperfusion and after a severe ischemic event [6]. This strategy activates an endogenous response in the myocardium that protects against reperfusion injury, which has been tested in several experimental models [7] and in clinical trials [8–11]. Protective mechanisms triggered by iPostC involve the activation of ‘Reperfusion Injury Salvage Kinases’ (RISK) [12,13], that includes the PI3K/AKT (Phosphatidyl-inositol 3-kinase/protein kinase B), MEK1/2/Erk1/2 (Mitogen Activated Kinases/ Extracellular signal Activated Kinases) [13–15] and the epsilon isoform of protein kinase C (PKCԑ) pathways [16,17].
Favorable and publicly funded studies are more likely to be published: a systematic review and meta-analysis
2017, Journal of Clinical EpidemiologyCitation Excerpt :Our literature review identified 34,469 unique records from the database search with an additional 12 identified via ancestry search of previous reviews. Ultimately, 85 cohorts of studies [4–6,8–11,31–108] qualified for inclusion (Fig. 2, Appendix Table 3 at www.jclinepi.com). The majority of records excluded did not track cohorts of studies to publication.
Ischemic Conditioning: Implications for Emergency Medicine
2016, Annals of Emergency MedicineCitation Excerpt :Preconditioning reduced enzymatic infarct size in experimental models by as much as 90%19 and improved clinical outcomes in patients undergoing both elective percutaneous coronary intervention20 and cardiac surgery.21 After percutaneous coronary intervention, postconditioning significantly reduced infarct size and other measures of reperfusion injury in patients with ST-segment elevation myocardial infarction (STEMI).22-25 Any interruptions of flow within an already compromised circulatory bed can add injury to the target organ (eg, from thrombotic debris or injury to the vessel wall).26
Ischemic Postconditioning Before Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction Reduces Contrast-induced Nephropathy and Improves Long-term Prognosis
2016, Archives of Medical ResearchCitation Excerpt :In 2005, Staat et al. (27) conducted a clinical phase II trial of IPoC and found that several brief repetitive cycles of reperfusion/stop irrigation prior to the continuous reperfusion protected against cardiac ischemic injury. Khan et al. reported that IPoC during PCI in patients with STEMI appeared to be superior to PCI alone in terms of reduction in myocardial injury and improvement in global and regional left ventricular function and that the effect seemed to be more pronounced when a greater myocardial area was at risk (28). In recent years, the study of IPoC on heart protection has received significant attention, but few reports have been published in regard to its protective effect on kidney.
The mechanisms of cardio-protective effects of desflurane and sevoflurane at the time of reperfusion: Anaesthetic post-conditioning potentially translatable to humans?
2016, British Journal of AnaesthesiaCitation Excerpt :Taken together, these speculated mechanisms suggest what future experimental studies need to concentrate on to understand the exact role of NO in halogenated anaesthetics induced-PostC. There has recently been great clinical expectation with volatile anaesthetic agents and two phenomena have been observed:85 86 a) myocardial infarct size reduction when they are given transiently before prolonged ischaemia (an effect whose size was comparable to ischaemic PreC) and b) a small increase of reactive oxygen species after anaesthetics might in turn trigger the conditioning action, through secondary messenger pathways.87 88 However, PostC despite numerous experimental studies on animals and on isolated myocardial cells as reviewed above, has not been applied in clinical practice such as ischaemic PostC during angioplasty.89
The value of cardiac magnetic resonance post-contrast T1 mapping in improving the evaluation of myocardial infarction
2023, Frontiers in Cardiovascular Medicine