Department of Cardiology P, Gentofte University Hospital, DK-2900 Hellerup, Denmark.
Int J Cardiol. 2010 Sep 24;144(1):22-5. doi: 10.1016/j.ijcard.2009.03.118. Epub 2009 May 5.
Myocardial postconditioning (POC), defined as intermittent interruptions of blood flow at the onset of reperfusion after sustained ischemia, may attenuate reperfusion injury. In order to weigh the current evidence linking POC to reduction of myocardial infarct size in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI), we performed a systematic review and meta-analysis of the available data from small randomised trials.
A Web-based search was performed for relevant studies, and retrieved data were subjected to systematic review and meta-analysis.
Six studies were identified and the meta-analysis included a total of 244 patients with STEMI undergoing pPCI with or without POC. Pooled analysis of all studies demonstrated a significant reduction of peak creatine kinase with POC relative to standard care (weighted mean peak creatine kinase difference -609.59 IU/L, 95% confidence interval [CI] -1030 to -189; p=0.005). A secondary analysis of 4 of the studies also showed an improvement of left ventricular ejection fraction with POC (weighted mean ejection fraction difference 4.2%, 95% CI 2.1% to 6.2%; p=0.0001).
This first systematic review and meta-analysis of randomized trials of POC in patients with STEMI undergoing primary PCI, demonstrated a significant benefit of POC over standard care for reduction of myocardial infarct size as determined by peak creatine kinase release and left ventricular ejection fraction. The effects of POC on clinical outcomes remain to be determined.
心肌后处理（POC）定义为在持续缺血后再灌注开始时中断血流，可能会减轻再灌注损伤。为了权衡目前的证据，将 POC 与接受直接经皮冠状动脉介入治疗（pPCI）的 ST 段抬高型心肌梗死（STEMI）患者的心肌梗死面积缩小联系起来，我们对小型随机试验的现有数据进行了系统评价和荟萃分析。
进行了基于网络的相关研究检索，并对检索到的数据进行了系统评价和荟萃分析。
确定了 6 项研究，荟萃分析共纳入 244 例接受 pPCI 治疗的 STEMI 患者，其中包括或不包括 POC。所有研究的汇总分析显示，与标准治疗相比，POC 可显著降低峰值肌酸激酶（加权平均峰值肌酸激酶差值 -609.59IU/L，95%置信区间 [CI] -1030 至 -189；p=0.005）。对其中 4 项研究的二次分析还显示，POC 可改善左心室射血分数（加权平均射血分数差值 4.2%，95% CI 2.1%至 6.2%；p=0.0001）。
这是第一项关于接受直接 PCI 的 STEMI 患者接受 POC 的随机试验的系统评价和荟萃分析，结果表明，与标准治疗相比，POC 可显著降低心肌梗死面积，通过峰值肌酸激酶释放和左心室射血分数来确定。POC 对临床结局的影响仍有待确定。
