| Purpose:The prognosis of acute myocardial infarction(AMI)has improved significantly since percutaneous coronary intervention(PCI)was applied in clinic,but the injury caused by ischemia/reperfusion can not be ignored.Many studies have confirmed that ischemic postconditioning(IPc)can alleviate ischemia/reperfusion injury.A meta-analysis of IPc of randomized controlled trials(RCTs)on patients with ST segment elevation myocardial infarction(STEMI)in recent years,including local ischemic postconditioning(LIPc)and remote ischemic postconditioning(RIPc),was conducted to evaluate the effect of clinical intervention..Method:Literatures were retrieved according to the set retrieval strategy,30 articles were selected according to inclusion criteria and exclusion criteria for discussion.The related indicators discussed were peak creatine kinase(CK),peak creatine kinase-MB isoenzyme(CK-MB),peak troponin,CK area under the curve(AUC),CK-MB AUC,Troponin AUC,left ventricular ejection fraction(LVEF),death,heart failure and reinfarction.Mean difference(MD),standardized mean difference(SMD)and relative risk(RR)were used to evaluate the efficiency of interventions.The effects were expressed in the form of 95% confidence interval(CI).Results : Compared with routine PCI,IPc can reduce CK-AUC(SMD-1.15,95% CI-2.18 to-0.13;P=0.03)and CK-MB AUC(SMD-0.27,95% CI-0.49 to-0.06;P=0.01).The effect of reducing CK-MB AUC comes from RIPc(SMD-0.41,95%CI-0.70 to-0.11;P=0.008),not LIPc(SMD-0.12,95% CI-0.47 to 0.23;P=0.51).However,IPc has no significant effect on peak CK,peak CK-MB,peak Troponin and Troponin AUC.In the subgroup analysis,it showed that IPc group did not significantly increase LVEF within 6 months,but significantly increased LVEF(MD 8.61,95% CI 3.41 to 13.82;P=0.001)when the follow-up time was extended to 1 year,with statistical significance;from LIPc(MD 2.30,95% CI-0.12 to 4.73;P=0.06)and RIPc(MD 0.54,95% CI 1.34 to 1.82);2.42;P= 0.57)on the impact of LVEF,showing a more effective trend of LIPc;LIPc 30 s group and LIPc 60 s group had no significant improvement on LVEF.IPc can not reduce mortality(RR 1.15,95% CI 0.74 to 1.78;P=0.54)and reinfarction rate(RR 2.48,95% CI 0.93 to 6.64;P=0.07),while LIPc tended to increase reinfarction rate(RR 3.29,95% CI 1.08 to 10.04;P=0.04)and reduce the incidence of heart failure(RR 0.62,95% CI 0.40 to 0.96;P=0.03).Conclusion:IPc can reduce the release of myocardial enzymes and increase the long-term LVEF in STEMI patients,but it has no significant improvement on major cardiovascular adverse events(MACE)(death,heart failure and reinfarction).The protective effects of IPc on the heart is not exact.Because of the limited sample size and significant heterogeneity,the results should be treated with caution. |
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