Effect of gender and treatment strategy on remote ischemic preconditioning-induced reduction of myocardial damage in patients undergoing cardiac surgery: a meta analysis
10.3760/cma.j.issn.0254-1416.2013.06.002
- VernacularTitle:性别因素和处理策略对远隔缺血预处理减轻心脏手术患者心肌损伤的影响:meta分析
- Author:
Chenghui ZHOU
;
Yuntai YAO
;
Huatong LI
;
Weipeng WANG
;
Lihuan LI
- Publication Type:Journal Article
- Keywords:
Sex factors;
Ischemic preconditioning;
Adult;
Surgical procedures,operative;
Heart;
Myocardial reperfusion injury;
Meta-analysis
- From:
Chinese Journal of Anesthesiology
2013;33(6):657-660
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the effect of gender and treatment strategy on remote ischemic preconditioning (RIPC)-induced reduction of myocardial damage in patients undergoing cardiac surgery.Methods We systematically searched the literature in PubMed,EMBase,and Cochrane Library (from Feb 1990 to Feb 2012) using the related keywords.Randomized control trials (RCTs) published in English with report on postoperative biomarkers of myocardial damage concerning RIPC-induced myocardial protection in adult patients undergoing cardiac surgery were included.Standardized mean difference (SMD) was calculated.Publication bias and sensitivity analysis were used to evaluate the reliability of overall enzymatic estimate.Meta-regression analysis was performed to explore the potential sources of significant heterogeneity among results of studies.Data were analyzed using Stata 12.0.Results Thirteen RCTs involving 985 patients were included in our study.Compared with controls,RIPC significantly reduced postoperative serum levels of biomarkers of myocardial damage with significant heterogeneity (SMD=-0.539; 95％CI:-0.926to-0.152; P＜0.05; I2 =88.7％,P＜0.01).No evidence of obvious publication bias was observed (P =0.083,Begg' s test; P =0.077,Egger' s test).Sensitivity analysis showed that each individual study produced no effect on the direction and magnitude of the overall effect size (P ＜ 0.05).Meta-regression analysis revealed that male (％) (coefficient =0.02 ; 95 ％ CI:-0.002-0.042 ; P =0.070 ; adjusted R2 =19.61％) and total ischemic time (min) (coefficient=-0.08; 95％CI:-0.154-0.002; P =0.055; adjusted R2 =19.47％) were the two major influential factors.Conclusion Gender affects RIPC-induced reduction of myocardial damage after cardiac surgery in patients,RIPC-induced reduction of myocardial damage infemale patients is superior to that in male patients and a better efficacy can be achieved by prolonging the single ischemic time or by increasing the ischemic cycles.
