Effect Of Ischemic Postconditioning On Ischemia Reperfusion Injury In Patients With Acute ST-segment Elevation Myocardial Infarction: A Meta-analysis

Objective: To systematically evaluate the effect of ischemic postconditio ning combined with PCI on myocardial ischemia reperfusion injury in STEMI patients.Methods: Pub Med,Embase,Cochrane,CBM,CNKI and Wan Fang data base were systematically searched to collect all prospective randomized contro lled trials on the effect of ischemic postconditioning on myocardial ischemia r eperfusion injury in patients with acute ST-segment elevation myocardial infar ction from establishment of these database to December 2022.The main outco me measures were creatine kinase(CK)peak,creatine kinase-MB(CK-MB)p eak and left ventricular ejection fraction(LVEF).The secondary outcome mea sures were corrected TIMI frame count(CTFC),the incidence of reperfusion a rrhythmia in a short time after operation,and the incidence of ST-segment res olution >50% after operation.Note Express3.5.0 software was used for strict sc reening according to the established inclusion and exclusion criteria,and Rev Man5.3 software was used for statistical analysis.Results: A total of 16 studies were included,with a total sample size of 1414 cases,including 688 cases in the ischemic postconditioning group and 726 cases in the control group.Statistical analysis showed that ischemic postcondi tioning combined with PCI significantly reduced peak of CK release(WMD:-767.65,95%CI[-897.54,-637.77],P<0.05)and peak of CK-MB release(WMD:-54.57,95%CI[-58.67,-50.47],P<0.05),increased left ventri cular ejection fraction(WMD:2.72,95%CI[1.83,3.60],P<0.05),and decreased corrected TIMI frame count(WMD:-4.70,95%CI[-6.20,-3.21],P<0.05),reduced the incidence of reperfusion arrhythmia in the short ti me after operation(RR: 0.38,95%CI[0.16,0.90],P=0.03),and increased the i ncidence of ST-segment resolution >50%(RR: 1.40,95%CI[1.14,1.71],P=0.001).Conclusions: Compared with routine emergency PCI,ischemic postcond itioning combined with emergency PCI can(1).Reduce the release peak of CK and CK-MB during reperfusion.(2).Increased left ventricular ejection fraction within 3 months after surgery.(3).Decrease the number of TIMI frames correct ed during operation.(4).To reduce the incidence of reperfusion arrhythmia with in a short time after surgery and increase the incidence of ST segment regressi on >50% after surgery,this conclusion needs to be treated with caution due to few studies.