Short-and long-term effects of ischemic postconditioning in STEMI patients: a meta-analysis

Lipids in Health and Disease

Yining Yang¹  Qingjie Chen¹  Bangdang Chen¹  Yingying Zheng¹  Fen Liu¹  Junyi Luo¹  Jing Gao² 

[1] Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi 830054, P.R., China;Department of endocrinology, Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, P.R.China

关键词: Infarct size;    Cardioprotection;    Ischemic/reperfusion injury;    STEMI;    Ischemic postconditioning;   

Others  :  1234450
DOI  :  10.1186/s12944-015-0151-x

 received in 2015-10-15, accepted in 2015-11-06,  发布年份 2015

【 摘 要 】

Background

Compelling evidence from large randomized trials demonstrates the salutary effects of ischemic postconditioning on cardioprotection against ischemic/reperfusion injury. However, some studies appear negative findings.

This study was designed to assess the short-and long-term effects of postconditioning (Poc) in studies including evolving ST-elevation myocardial infarction (STEMI).

Methods

Relevant studies were identified through an electronic literature search from the PubMed, Library of Congress, Embase, Cochrane Central Register of Controlled Trials, and ISI Web of Science. Studies published up to December 2014 were eligible for inclusion. Patients older than 18 years presenting within 12 h of the first STEMI and eligible for angioplasty were considered for the study.

Results

The 25 trials allocated 1136 patients to perform locational postconditioning cycles at the onset of reperfusion and 1153 patients to usual percutaneous coronary intervention (PCI). Ischemic postconditioning demonstrated a decrease in serum cardiac enzymes creatine kinase (CK) and CK-MB (P < 0.00001 and P =0.25, respectively) in the subgroup analysis based on direct stenting. Reduction in infarct size by imaging was showed during7 days after myocardial infarction (P =0.01), but not in the longterm (P = 0.08). The wall motion score index was improved in both the short term within 7 days (P = 0.009) and the long term over 6 months after receiving Poc (P = 0.02). All included studies were limited by the high risk of performance and publication bias.

Conclusions

Ischemic postconditioning by brief interruptions of coronary blood flow at the onset of reperfusion after PCI appears to be superior to PCI alone in reducing myocardial injury and improving left ventricular function, especially in patients who have received direct stenting in PCI.

【 授权许可】

   
2015 Gao et al.

【 图 表 】

Fig. 1.

Fig. 2.

Fig. 3.

Fig. 4.

Fig. 5.

Fig. 6.

Fig. 7.

Fig. 8.

Fig. 9.

Fig. 10.

【 参考文献 】

• [1]Ito H, Okamura A, Iwakura K, Masuyama T, Hori M, Takiuchi S et al.. Myocardial perfusion patterns related to thrombolysis in myocardial infarction perfusion grades after coronary angioplasty in patients with acute anterior wall myocardial infarction. Circulation. 1996; 93:1993-9.
• [2]Granfeldt A, Lefer DJ, Vinten-Johansen J. Protective ischaemia in patients: preconditioning and postconditioning. Cardiovasc Res. 2009; 83:234-46.
• [3]Crisostomo PR, Wairiuko GM, Wang M, Tsai BM, Morrell ED, Meldrum DR. Preconditioning versus postconditioning: mechanisms and therapeutic potentials. J Am Coll Surg. 2006; 202:797-812.
• [4]Hausenloy DJ, Yellon DM. Preconditioning and postconditioning: underlying mechanisms and clinical application. Atherosclerosis. 2009; 204:334-41.
• [5]Fan Q, Yang XC, Liu Y, Wang LF, Liu SH, Ge YG et al.. Postconditioning attenuates myocardial injury by reducing nitro-oxidative stress in vivo in rats and in humans. Clin Sci (Lond). 2011; 120:251-61.
• [6]Zhao WS, Xu L, Wang LF, Zhang L, Zhang ZY, Liu Y et al.. A 60-s postconditioning protocol by percutaneous coronary intervention inhibits myocardial apoptosis in patients with acute myocardial infarction. Apoptosis. 2009; 14:1204-11.
• [7]Yang XC, Liu Y, Wang LF, Cui L, Wang T, Ge YG et al.. Reduction in myocardial infarct size by postconditioning in patients after percutaneous coronary intervention. J Invasive Cardiol. 2007; 19:424-30.
• [8]Thuny F, Lairez O, Roubille F, Mewton N, Rioufol G, Sportouch C et al.. Post-conditioning reduces infarct size and edema in patients with ST-segment elevation myocardial infarction. J Am Coll Cardiol. 2012; 59:2175-81.
• [9]Ma XJ, Zhang XH, Li CM, Luo M. Effect of postconditioning on coronary blood flow velocity and endothelial function in patients with acute myocardial infarction. Scand Cardiovasc J. 2006; 40:327-33.
• [10]Freixa X, Bellera N, Ortiz-Perez JT, Jimenez M, Pare C, Bosch X et al.. Ischaemic postconditioning revisited: lack of effects on infarct size following primary percutaneous coronary intervention. Eur Heart J. 2012; 33:103-12.
• [11]Limalanathan S, Andersen GO, Klow NE, Abdelnoor M, Hoffmann P, Eritsland J. Effect of ischemic postconditioning on infarct size in patients with ST-elevation myocardial infarction treated by primary PCI results of the POSTEMI (POstconditioning in ST-Elevation Myocardial Infarction) randomized trial. J Am Heart Assoc. 2014; 3: Article ID e000679
• [12]Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003; 327:557-60.
• [13]Tarantini G, Favaretto E, Napodano M, Perazzolo Marra M, Cacciavillani L, Babuin L et al.. Design and methodologies of the POSTconditioning during coronary angioplasty in acute myocardial infarction (POST-AMI) trial. Cardiology. 2010; 116:110-6.
• [14]Limalanathan S, Andersen GO, Hoffmann P, Klow NE, Abdelnoor M, Eritsland J. Rationale and design of the POSTEMI (postconditioning in ST-elevation myocardial infarction) study. Cardiology. 2010; 116:103-9.
• [15]Laskey WK. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions. Catheter Cardiovasc Interv. 2005; 65:361-7.
• [16]Crimi G, Pica S, Raineri C, Bramucci E, De Ferrari GM, Klersy C et al.. Remote ischemic post-conditioning of the lower limb during primary percutaneous coronary intervention safely reduces enzymatic infarct size in anterior myocardial infarction: a randomized controlled trial. JACC Cardiovasc Interv. 2013; 6:1055-63.
• [17]Carrasco-Chinchilla F, Munoz-Garcia AJ, Dominguez-Franco A, Millan-Vazquez G, Guerrero-Molina A, Ortiz-Garcia C et al.. Remote ischaemic postconditioning: does it protect against ischaemic damage in percutaneous coronary revascularisation? Randomised placebo-controlled clinical trial. Heart. 2013; 99:1431-7.
• [18]Prunier F, Angoulvant D, Saint Etienne C, Vermes E, Gilard M, Piot C et al.. The RIPOST-MI study, assessing remote ischemic perconditioning alone or in combination with local ischemic postconditioning in ST-segment elevation myocardial infarction. Basic Res Cardiol. 2014; 109:400.
• [19]Smul TM, Lange M, Redel A, Stumpner J, Lotz CA, Roewer N et al.. Desflurane-induced cardioprotection against ischemia-reperfusion injury depends on timing. J Cardiothorac Vasc Anesth. 2009; 23:600-6.
• [20]Pagel PS, Krolikowski JG, Amour J, Warltier DC, Weihrauch D. Morphine reduces the threshold of helium preconditioning against myocardial infarction: the role of opioid receptors in rabbits. J Cardiothorac Vasc Anesth. 2009; 23:619-24.
• [21]Lucchinetti E, Ambrosio S, Aguirre J, Herrmann P, Härter L, Keel M et al.. Sevoflurane inhalation at sedative concentrations provides endothelial protection against ischemia-reperfusion injury in humans. Anesthesiology. 2007; 106:262-8.
• [22]Huang Z, Zhong X, Irwin MG, Ji S, Wong GT, Liu Y et al.. Synergy of isoflurane preconditioning and propofol postconditioning reduces myocardial reperfusion injury in patients. Clin Sci (Lond). 2011; 121:57-69.
• [23]Zhang R, Shen L, Xie Y, Gen L, Li X, Ji Q. Effect of morphine-induced postconditioning in corrections of tetralogy of fallot. J Cardiothorac Surg. 2013; 8:76. BioMed Central Full Text
• [24]Beck-Schimmer B, Breitenstein S, Bonvini JM, Lesurtel M, Ganter M, Weber A et al.. Protection of pharmacological postconditioning in liver surgery: results of a prospective randomized controlled trial. Ann Surg. 2012; 256:837-44.
• [25]Loukogeorgakis SP, Panagiotidou AT, Yellon DM, Deanfield JE, MacAllister RJ. Postconditioning protects against endothelial ischemia-reperfusion injury in the human forearm. Circulation. 2006; 113:1015-9.
• [26]Deftereos S, Giannopoulos G, Tzalamouras V, Raisakis K, Kossyvakis C, Kaoukis A et al.. Renoprotective effect of remote ischemic post-conditioning by intermittent balloon inflations in patients undergoing percutaneous coronary intervention. J Am Coll Cardiol. 2013; 61:1949-55.
• [27]Luo W, Li B, Chen R, Huang R, Lin G. Effect of ischemic postconditioning in adult valve replacement. Eur J Cardiothorac Surg. 2008; 33:203-8.
• [28]Dragoni S, Di Stolfo G, Sicuro S, Lisi M, Parker JD, Forconi S et al.. Postconditioning fails to prevent radial artery endothelial dysfunction induced by ischemia and reperfusion: evidence from a human in vivo study. Can J Physiol Pharmacol. 2006; 84:611-5.
• [29]Li B, Chen R, Huang R, Luo W. Clinical benefit of cardiac ischemic postconditioning in corrections of tetralogy of Fallot. Interact Cardiovasc Thorac Surg. 2009; 8:17-21.
• [30]Ji Q, Mei Y, Wang X, Feng J, Wusha D, Cai J et al.. Effect of ischemic postconditioning in correction of tetralogy of Fallot. Int Heart J. 2011; 52:312-7.
• [31]Chen R, Luo WJ, Jiang HH, Long L, Huang RM, Luo FY. Cardiopulmonary protection of ischemic postconditioning in cardiac surgery in children with tetralogy of Fallot. Zhongguo Dang Dai Er Ke Za Zhi. 2009; 11:273-6.
• [32]Durdu S, Sirlak M, Cetintas D, Inan MB, Eryilmaz S, Ozcinar E et al.. The efficacies of modified mechanical post conditioning on myocardial protection for patients undergoing coronary artery bypass grafting. J Cardiothorac Surg. 2012; 7:73. BioMed Central Full Text
• [33]Kim JC, Shim JK, Lee S, Yoo YC, Yang SY, Kwak YL. Effect of combined remote ischemic preconditioning and postconditioning on pulmonary function in valvular heart surgery. Chest. 2012; 142:467-75.
• [34]Zhong H, Gao Z, Chen M, Zhao J, Wang F, Li L et al.. Cardioprotective effect of remote ischemic postconditioning on children undergoing cardiac surgery: a randomized controlled trial. Paediatr Anaesth. 2013; 23:726-33.
• [35]Kim WH, Lee JH, Kim GS, Sim HY, Kim SJ. The effect of remote ischemic postconditioning on graft function in patients undergoing living donor kidney transplantation. Transplantation. 2014; 98:529-36.
• [36]Luo W, Zhu M, Huang R, Zhang Y. A comparison of cardiac post-conditioning and remote pre-conditioning in paediatric cardiac surgery. Cardiol Young. 2011; 21:266-70.
• [37]Hong DM, Jeon Y, Lee CS, Kim HJ, Lee JM, Bahk JH et al.. Effects of remote ischemic preconditioning with postconditioning in patients undergoing off-pump coronary artery bypass surgery--randomized controlled trial. Circ J. 2012; 76:884-90.
• [38]Staat P, Rioufol G, Piot C, Cottin Y, Cung TT, L’Huillier I et al.. Postconditioning the human heart. Circulation. 2005; 112:2143-8.
• [39]Ma XJ, Zhang XH, Luo M, Li CM, Shao JH. Effects of preconditioning and postconditioning on emergency percutaneous coronary intervention in patients with acute myocardial infarction. Zhonghua Yi Xue Za Zhi. 2007; 87:114-7.
• [40]Laskey WK, Yoon S, Calzada N, Ricciardi MJ. Concordant improvements in coronary flow reserve and ST-segment resolution during percutaneous coronary intervention for acute myocardial infarction: a benefit of postconditioning. Catheter Cardiovasc Interv. 2008; 72:212-20.
• [41]Thibault H, Piot C, Staat P, Bontemps L, Sportouch C, Rioufol G et al.. Long-term benefit of postconditioning. Circulation. 2008; 117:1037-44.
• [42]Lin XM, Zhang ZY, Wang LF, Zhang L, Liu Y, Liu XL et al.. Attenuation of tumor necrosis factor-alpha elevation and improved heart function by postconditioning for 60 seconds in patients with acute myocardial infarction. Chin Med J (Engl). 2010; 123:1833-9.
• [43]Lonborg J, Holmvang L, Kelbaek H, Vejlstrup N, Jorgensen E, Helqvist S et al.. ST-Segment resolution and clinical outcome with ischemic postconditioning and comparison to magnetic resonance. Am Heart J. 2010; 160:1085-91.
• [44]Lonborg J, Kelbaek H, Vejlstrup N, Jorgensen E, Helqvist S, Saunamaki K et al.. Cardioprotective effects of ischemic postconditioning in patients treated with primary percutaneous coronary intervention, evaluated by magnetic resonance. Circ Cardiovasc Interv. 2010; 3:34-41.
• [45]Sorensson P, Saleh N, Bouvier F, Bohm F, Settergren M, Caidahl K et al.. Effect of postconditioning on infarct size in patients with ST elevation myocardial infarction. Heart. 2010; 96:1710-5.
• [46]Xue F, Yang X, Zhang B, Zhao C, Song J, Jiang T et al.. Postconditioning the human heart in percutaneous coronary intervention. Clin Cardiol. 2010; 33:439-44.
• [47]Garcia S, Henry TD, Wang YL, Chavez IJ, Pedersen WR, Lesser JR et al.. Long-term follow-up of patients undergoing postconditioning during ST-elevation myocardial infarction. J Cardiovasc Transl Res. 2011; 4:92-8.
• [48]Liu TK, Mishra AK, Ding FX. Protective effect of ischemia postconditioning on reperfusion injury in patients with ST-segment elevation acute myocardial infarction. Zhonghua Xin Xue Guan Bing Za Zhi. 2011; 39:35-9.
• [49]Tarantini G, Favaretto E, Marra MP, Frigo AC, Napodano M, Cacciavillani L et al.. Postconditioning during coronary angioplasty in acute myocardial infarction: the POST-AMI trial. Int J Cardiol. 2012; 162:33-8.
• [50]Zhao CM, Yang XJ, Yang JH, Cheng XJ, Zhao X, Zhou BY et al.. Effect of ischaemic postconditioning on recovery of left ventricular contractile function after acute myocardial infarction. J Int Med Res. 2012; 40:1082-8.
• [51]Dwyer NB, Mikami Y, Hilland D, Aljizeeri A, Friedrich MG, Traboulsi M et al.. No cardioprotective benefit of ischemic postconditioning in patients with ST-segment elevation myocardial infarction. J Interv Cardiol. 2013; 26:482-90.
• [52]Elzbieciak M, Wita K, Grabka M, Chmurawa J, Doruchowska A, Turski M et al.. Effect of postconditioning on infarction size, adverse left ventricular remodeling, and improvement in left ventricular systolic function in patients with first anterior STsegment elevation myocardial infarction. Pol Arch Med Wewn. 2013; 123:268-76.
• [53]Hahn JY, Song YB, Kim EK, Yu CW, Bae JW, Chung WY et al.. Ischemic postconditioning during primary percutaneous coronary intervention: the effects of postconditioning on myocardial reperfusion in patients with ST-segment elevation myocardial infarction (POST) randomized trial. Circulation. 2013; 128:1889-96.
• [54]Mewton N, Thibault H, Roubille F, Lairez O, Rioufol G, Sportouch C et al.. Postconditioning attenuates no-reflow in STEMI patients. Basic Res Cardiol. 2013; 108:383.
• [55]Sorensson P, Ryden L, Saleh N, Tornvall P, Arheden H, Pernow J. Long-term impact of postconditioning on infarct size and left ventricular ejection fraction in patients with ST-elevation myocardial infarction. BMC Cardiovasc Disord. 2013; 13:22. BioMed Central Full Text
• [56]Dong M, Mu N, Guo F, Zhang C, Ren F, Li J et al.. The beneficial effects of postconditioning on no-reflow phenomenon after percutaneous coronary intervention in patients with ST-elevation acute myocardial infarction. J Thromb Thrombolysis. 2014; 38:208-14.
• [57]Waltenberger J, Gelissen M, Bekkers SC, Vainer J, van Ommen V, Eerens F et al.. Clinical pacing post-conditioning during revascularization after AMI. JACC Cardiovasc Imaging. 2014; 7:620-6.
• [58]Kloner RA, Jennings RB. Consequences of brief ischemia: stunning, preconditioning, and their clinical implications: part 2. Circulation. 2001; 104:3158-67.
• [59]Hausenloy DJ, Yellon DM. Preconditioning and postconditioning: new strategies for cardioprotection. Diabetes Obes Metab. 2008; 10:451-9.
• [60]Piper HM, Meuter K, Schafer C. Cellular mechanisms of ischemia-reperfusion injury. Ann Thorac Surg. 2003; 75:S644-8.
• [61]Stone GW, Dixon SR, Grines CL, Cox DA, Webb JG, Brodie BR et al.. Predictors of infarct size after primary coronary angioplasty in acute myocardial infarction from pooled analysis from four contemporary trials. Am J Cardiol. 2007; 100:1370-5.
• [62]Hausenloy DJ, Duchen MR, Yellon DM. Inhibiting mitochondrial permeability transition pore opening at reperfusion protects against ischaemia-reperfusion injury. Cardiovasc Res. 2003; 60:617-25.
• [63]Ciccone MM, Cortese F, Gesualdo M, Carbonara S, Zito A, Ricci G et al.. Dietary intake of carotenoids and their antioxidant and anti-inflammatory effects in cardiovascular care. Mediators Inflamm. 2013; 2013:782137.
• [64]Penna C, Tullio F, Moro F, Folino A, Merlino A, Pagliaro P. Effects of a protocol of ischemic postconditioning and/or captopril in hearts of normotensive and hypertensive rats. Basic Res Cardiol. 2010; 105:181-92.
• [65]Wagner C, Ebner B, Tillack D, Strasser RH, Weinbrenner C. Cardioprotection by ischemic postconditioning is abrogated in hypertrophied myocardium of spontaneously hypertensive rats. J Cardiovasc Pharmacol. 2013; 61:35-41.
• [66]Przyklenk K. Efficacy of cardioprotective ‘conditioning’ strategies in aging and diabetic cohorts: the co-morbidity conundrum. Drugs Aging. 2011; 28:331-43.
• [67]Darling CE, Solari PB, Smith CS, Furman MI, Przyklenk K. ‘Postconditioning’ the human heart: multiple balloon inflations during primary angioplasty may confer cardioprotection. Basic Res Cardiol. 2007; 102:274-8.
• [68]Whittington HJ, Harding I, Stephenson CI, Bell R, Hausenloy DJ, Mocanu MM et al.. Cardioprotection in the aging, diabetic heart: the loss of protective Akt signalling. Cardiovasc Res. 2013; 99:694-704.