接受直接经皮冠状动脉介入治疗的ST段抬高型心肌梗死患者中，远程缺血预处理与缺血后处理在梗死面积、ST段完全恢复发生率、死亡率、再梗死及靶血管血运重建方面的比较。

Comparison of infarction size, complete ST-segment resolution incidence, mortality and re-infarction and target vessel revascularization between remote ischemic conditioning and ischemic postconditioning in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.

作者信息

Zhang Haozhou, Yang Lei, Wang Lei

机构信息

Department of Cardiology, Shanxi Province Cardiovascular Hospital, Taiyuan, China.

Department of Cardiology, The Affiliated Cardiovascular Hospital of Shanxi Medical University, Taiyuan, China.

出版信息

Postepy Kardiol Interwencyjnej. 2020 Sep;16(3):278-286. doi: 10.5114/aic.2020.99262. Epub 2020 Oct 2.

INTRODUCTION

Due to higher morbidity and mortality, ST-segment elevation myocardial infarction (STEMI) causes many public health problems.

AIM

To observe effects of remote ischemic conditioning (RIC) and ischemic postconditioning (IPC) on patients diagnosed as STEMI undergoing primary percutaneous coronary intervention (pPCI).

MATERIAL AND METHODS

This meta-analysis was conducted using indirect comparison by conducting a network meta-analysis (NMA). We conducted searches by utilizing PubMed and the other databases to identify randomized controlled trials (RCTs) that described IPC or RIC treated patients diagnosed with STEMI during processes of pPCI. Enzymatic infarct size and infarction size were evaluated and cardiac events were assessed during the follow-up.

RESULTS

Pooled results showed that lower enzymatic infarction size was associated with the RIC group compared to the IPC group (IPC . RIC: standardized mean difference (SMD) = 1.126; 95% confidence interval (CI): 0.756-1.677). Compared with IPC, RIC significantly reduced infarction size, which was assessed using cardiac magnetic resonance (CMR) (SMD = 1.113; 95% CI: 0.674-1.837). We noted a potential toward greater complete ST-segment resolution in RIC patients compared with IPC patients (odds ratio (OR) = 0.821; 95% CI: 0.166-4.051). No significant difference existed in all-cause mortality (OR = 2.211; 95% CI: 0.845-5.784), Target vessel revascularization (TVR) (OR = 0.045; 95% CI: 0.001-.662) or re-infarction (OR = 1.763; 95% CI: 0.741-4.193).

CONCLUSIONS

This meta-analysis suggested RIC was correlated with significantly smaller infarction size compared to IPC. No significant superiority between RIC and IPC has been observed in this study on cSTR incidence, mortality and re-infarction or TVR.

引言

由于更高的发病率和死亡率，ST段抬高型心肌梗死（STEMI）引发了许多公共卫生问题。

目的

观察远程缺血预处理（RIC）和缺血后处理（IPC）对诊断为STEMI并接受直接经皮冠状动脉介入治疗（pPCI）的患者的影响。

材料与方法

本荟萃分析采用网络荟萃分析（NMA）进行间接比较。我们利用PubMed和其他数据库进行检索，以识别描述在pPCI过程中接受IPC或RIC治疗的诊断为STEMI患者的随机对照试验（RCT）。在随访期间评估酶促梗死面积和梗死面积，并评估心脏事件。

结果

汇总结果显示，与IPC组相比，RIC组的酶促梗死面积更低（IPC对RIC：标准化均数差（SMD）=1.126；95%置信区间（CI）：0.756-1.677）。与IPC相比，RIC显著减小了梗死面积，这是通过心脏磁共振（CMR）评估的（SMD=1.113；95%CI：0.674-1.837）。我们注意到，与IPC患者相比，RIC患者有更大的完全ST段分辨率的趋势（优势比（OR）=0.821；95%CI：0.166-4.051）。全因死亡率（OR=2.211；95%CI：0.845-5.784）、靶血管血运重建（TVR）（OR=0.045；95%CI：0.001-0.662）或再梗死（OR=1.763；95%CI：0.741-4.193）方面无显著差异。