Rabin Medical Center Beilinson Hospital, Petah Tikva, Israel
Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.
Open Heart. 2024 Jan 29;11(1):e002281. doi: 10.1136/openhrt-2023-002281.
This study aimed to perform a meta-analysis of the short-term impact of ischaemic postconditioning (IPoC) on myocardial injury in ST elevation myocardial infarction (STEMI) using surrogate cardiac biomarkers.
Eligible studies were identified using several article databases. Randomised controlled trials published between 1 January 2000 and 1 December 2021 comparing IPoC to standard of therapy in STEMI patients were included in the search. Outcomes included surrogates of myocardial injury, specifically peak troponin, creatine-kinase (CK) and CK myoglobin binding (CK-MB) enzyme levels.
11 articles involving 1273 patients reported on CK-MB and 8 studies involving 505 patients reported on CK. Few studies used troponin as an outcome, thus, a subanalysis of troponin dynamics was not performed. Meta-regression analysis demonstrated no significant effect of IPoC on peak CK-MB (effect size -0.41, 95% CI -1.15 to 0.34) or peak CK (effect size -0.42, 95% CI -1.20 to 0.36). Linear regression analysis demonstrated a significant correlation between a history of smoking and CK-MB in the IPoC group (p=0.038).
IPoC does not seem to protect against myocardial injury in STEMI, except possibly in smokers. These results resonate with some studies using imaging techniques to ascertain myocardial damage. More research using troponin and cardiac imaging should be pursued to better assess the effects of IPoC on cardiovascular outcomes in STEMI.
本研究旨在使用替代心脏生物标志物对缺血后处理（IPoC）对 ST 段抬高型心肌梗死（STEMI）心肌损伤的短期影响进行荟萃分析。
使用多个文献数据库确定了合格的研究。检索范围包括 2000 年 1 月 1 日至 2021 年 12 月 1 日期间发表的比较 IPoC 与 STEMI 患者标准治疗的随机对照试验。结果包括心肌损伤的替代标志物，特别是肌钙蛋白峰值、肌酸激酶（CK）和 CK 肌红蛋白结合（CK-MB）酶水平。
11 项涉及 1273 例患者的 CK-MB 和 8 项涉及 505 例患者的 CK 研究报告了结果。很少有研究将肌钙蛋白作为结果，因此未进行肌钙蛋白动力学的亚分析。荟萃回归分析表明，IPoC 对 CK-MB 峰值（效应大小 -0.41，95%CI -1.15 至 0.34）或 CK 峰值（效应大小 -0.42，95%CI -1.20 至 0.36）没有显著影响。线性回归分析表明，在 IPoC 组中，吸烟史与 CK-MB 之间存在显著相关性（p=0.038）。
IPoC 似乎不能预防 STEMI 中的心肌损伤，除了可能在吸烟者中。这些结果与一些使用成像技术确定心肌损伤的研究结果一致。应该进行更多使用肌钙蛋白和心脏成像的研究，以更好地评估 IPoC 对 STEMI 心血管结局的影响。
