Graduate School, Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China.
Catheter Cardiovasc Interv. 2013 Nov 1;82(5):E662-71. doi: 10.1002/ccd.25095. Epub 2013 Jul 19.
The aim of present analysis was to evaluate the effect of postconditioning in primary percutaneous coronary intervention (pPCI).
Although postconditioning in pPCI has shown potential favorable effects on reperfusion injury, recent trials have yielded divergent results.
Randomized controlled trials were identified using relevant databases published up to August 15, 2012. Weighted mean difference (WMD) and standardized mean difference (SMD) were calculated using meta-analysis through fixed- or random-effects models. Statistical analysis was performed using RevMan 5.17 and Stata 12.0.
Thirteen studies providing myocardial biomarkers, left ventricular ejection fraction (LVEF) or infarct size evaluated by cardiac magnetic resonance (CMR) in a total of 725 ST-elevation acute myocardial infarction (STEMI) patients were identified. Compared with usual care, postconditioning significantly reduced myocardial injury biomarkers (SMD = -0.61; 95% Confidence Interval (CI): [-0.98, -0.23]; P = 0.001; I(2) = 78%). Univariate meta-regression analysis suggested potential source of heterogeneity were the type of biomarkers and the use of glycoprotein IIb/IIIa inhibitors (I(2) reg = 44.84% and 67.24%, respectively; R(2) = 91.53% and 49.46%, respectively). Secondary analysis showed statistical significant improvement of LVEF with postconditioning (WMD = 3.22%; 95%CI: [0.88%, 5.57%]; P = 0.007; I(2) = 60%) relative to usual care. The effect diminished during medium (<6 months) and long terms (≥6 months) (P = 0.86 and 0.15, respectively). There was no significant decrease in infarct size among patients treated with postconditioning compared to usual care (SMD = 0.20; 95%CI: [-0.03, 0.43]; P = 0.08; I(2) = 46%).
In STEMI patients undergoing pPCI, postconditioning is associated with significant lower level of myocardial injury biomarkers and a statistical significant improvement of LVEF relative to usual care. However, this adjunctive therapy may fails to reduce infarct size evaluated by CMR.
本分析旨在评估原发性经皮冠状动脉介入治疗（pPCI）中后处理的效果。
尽管 pPCI 中的后处理对再灌注损伤显示出潜在的有利影响，但最近的试验结果却存在差异。
使用相关数据库，检索截至 2012 年 8 月 15 日发表的随机对照试验。通过固定或随机效应模型，使用荟萃分析计算加权均数差（WMD）和标准化均数差（SMD）。使用 RevMan 5.17 和 Stata 12.0 进行统计分析。
共纳入 725 例 ST 段抬高型急性心肌梗死（STEMI）患者的 13 项研究，这些研究提供了心肌生物标志物、左心室射血分数（LVEF）或心脏磁共振（CMR）评估的梗死面积数据。与常规治疗相比，后处理显著降低了心肌损伤生物标志物（SMD=-0.61；95%置信区间：[-0.98，-0.23]；P=0.001；I²=78%）。单变量 meta 回归分析表明，潜在的异质性来源是生物标志物的类型和糖蛋白 IIb/IIIa 抑制剂的使用（I²reg=44.84%和 67.24%，R²=91.53%和 49.46%）。二次分析显示，与常规治疗相比，后处理后 LVEF 有统计学意义的改善（WMD=3.22%；95%置信区间：[0.88%，5.57%]；P=0.007；I²=60%）。在中（<6 个月）期和长（≥6 个月）期时，这种作用减弱（P=0.86 和 0.15）。与常规治疗相比，后处理组患者的梗死面积无显著减小（SMD=0.20；95%置信区间：[-0.03，0.43]；P=0.08；I²=46%）。
在接受 pPCI 的 STEMI 患者中，与常规治疗相比，后处理与心肌损伤生物标志物水平显著降低和 LVEF 统计学显著改善相关。然而，这种辅助治疗可能无法减少 CMR 评估的梗死面积。
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