Remote ischemic conditioning improves myocardial parameters and clinical outcomes during primary percutaneous coronary intervention: a meta-analysis of randomized controlled trials
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Hai Liu1,*, Li Fu2,*, Xiangke Sun3, Wei Peng3, Zhiwei Chen3 and Yiliang Li4,5
1Third Department of Cardiac Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
2Institute of Clinical Medicine, Department of Endocrinology, The Central Hospital of Loudi Affiliated to the University of South China, Loudi 417000, China
3Department of Cardiology, The Central Hospital of Loudi Affiliated to the University of South China, Loudi 417000, China
4Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
5Postdoctoral Research Workstation of Neurology, Clinical Medicine, The Third Xiangya Hospital, Central South University, Changsha 410013, China
*These authors contributed equally to this work and should be considered as co-first authors
Hai Liu, email: email@example.com
Yiliang Li, email: firstname.lastname@example.org
Keywords: remote ischemic conditioning; cardioprotection; clinical outcome; primary percutaneous coronary intervention
Received: July 10, 2017 Accepted: December 04, 2017 Published: December 22, 2017
We conducted a systematic review and meta-analysis to evaluate the effects of remote ischemic conditioning on myocardial parameters and clinical outcomes in ST segment elevation acute myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention. Ten eligible randomized controlled trials with 1006 STEMI patients were identified. Compared with controls, remote ischemic conditioning reduced the myocardial enzyme levels (standardized mean difference =-0.86; 95% CI: -1.44 to -0.28; P = 0.004; I2 = 94.5%), and increased the incidence of complete ST-segment resolution [odds ratio (OR) = 1.74; 95% CI: 1.09 to 2.77; P = 0.02; I2 = 47.9%]. Remote ischemic conditioning patients had a lower risk of all-cause mortality (OR = 0.27; 95% CI: 0.12 to 0.62; P = 0.002; I2 = 0.0%) and lower major adverse cardiovascular and cerebrovascular events rate (OR=0.45; 95% CI: 0.27 to 0.75; P = 0.002; I2 = 0.0%). Meta-analysis suggested that remote ischemic conditioning conferred cardioprotection by reducing myocardial enzymes and increasing the incidence of complete ST-segment resolution in patients after STEMI. As a result, clinical outcomes were improved in terms of mortality and incidence of major adverse cardiovascular and cerebrovascular events.
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