Department of Cardiology, Fujian Heart Medical Center, Fujian Medical University Union Hospital, Fujian Institute of Coronary Artery Disease, Fujian Institute of Geriatrics, Fujian, 350001, P. R. China.
Rev Cardiovasc Med. 2020 Mar 30;21(1):103-112. doi: 10.31083/j.rcm.2020.01.10.
Remote ischemic conditioning is usually associated with cardioprotective intervention against ischemia-reperfusion. However, the effect of remote ischemic preconditioning (RIC-pre) completed before myocardial reperfusion with intermittent limb ischemia-reperfusion in patients with STEMI undergoing primary percutaneous coronary intervention (PPCI) is unclear. PubMed, EMBASE, and the Cochrane Library were fully searched from the beginning of each database up to September 2019 to find seven RCTs, a total of 2796 patients with STEMI undergoing PPCI with RIC-pre and 2818 patients with STEMI undergoing PPCI alone. No significant discrepancy in cardiac death was observed between RIC-pre and control groups (RR 1.03, 95% CI [0.76-1.41], = 0.83, I = 40%). The incidences of hospitalization for heart failure (RR 1.03, 95% CI [0.85-1.25], = 0.77, I = 0%), myocardial infarction (RR 0.86, 95% CI [0.59-1.26], = 0.44, I = 0%), and stroke (RR 1.04, 95% CI [0.62-1.77], = 0.87, I = 0%) were not decreased in RIC-pre group when compared with control group. Subgroup analysis revealed similar risk in clinical adverse events at long- and short-term follow-up between two groups. However, peak of creatine kinase-myocardial band (CK-MB) was reduced in RIC-pre group (SWD -0.42, 95% CI [-0.77, -0.07], = 0.02, I = 34%). RIC-pre tended to a low peak of CK-MB in patients with STEMI undergoing PPCI, but lacked significant beneficial effects on improving clinical outcomes at long- and short-term follow-up.
远程缺血预处理（RIC-pre）通常与针对缺血再灌注的心脏保护干预相关。然而，在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）患者中，间歇性肢体缺血再灌注后进行心肌再灌注前的远程缺血预适应（RIC-pre）的效果尚不清楚。通过全面检索 PubMed、EMBASE 和 Cochrane Library 数据库，检索时间截至 2019 年 9 月，共纳入 7 项 RCT 研究，共 2796 例接受 PPCI 治疗的 STEMI 患者行 RIC-pre，2818 例患者仅接受 PPCI。RIC-pre 组与对照组在心脏死亡方面无显著差异（RR 1.03，95%CI [0.76-1.41]， = 0.83，I² = 40%）。RIC-pre 组与对照组在心力衰竭（RR 1.03，95%CI [0.85-1.25]， = 0.77，I² = 0%）、心肌梗死（RR 0.86，95%CI [0.59-1.26]， = 0.44，I² = 0%）和卒中（RR 1.04，95%CI [0.62-1.77]， = 0.87，I² = 0%）的住院发生率方面无降低。亚组分析显示，两组在长期和短期随访时的临床不良事件风险相似。然而，RIC-pre 组肌酸激酶同工酶-肌红蛋白（CK-MB）峰值降低（SWD -0.42，95%CI [-0.77，-0.07]， = 0.02，I² = 34%）。RIC-pre 可能会降低 STEMI 患者接受 PPCI 后的 CK-MB 峰值，但在长期和短期随访时对改善临床结局无显著有益作用。
