Letter to the Editor
Letter to the editor regarding the article “Cardioprotective role of ischemic postconditioning in acute myocardial infarction: A systematic review and meta-analysis” To the Editor, We read the article by Khan et al 1 reporting the cardioprotective effects of ischemic postconditioning in acute myocardial infarction and were puzzled by the discussion “Our results suggest that myocardial salvage is better in the anterior location compared with the inferior location because of a greater myocardial area being at risk.” As we know, myocardial salvage is defined as the difference between area at risk (AAR) and infarct size. The authors just referred AAR and highlighted its importance in the discussion; however, they did not show us the analysis of AAR or myocardial salvage between ischemic postconditioning during percutaneous coronary intervention and percutaneous coronary intervention alone, although AAR or myocardial salvage was listed in several articles (just listing part of them) 2-5 included in the meta-analysis. Therefore, it is inappropriate for the author to state that myocardial salvage differed between 2 groups. Moreover, it is necessary to determine myocardial salvage while evaluating the efficacy of reperfusion therapy. Besides, myocardial salvage index, myocardial salvage index = AAR − infarct size/AAR, is considered to be a strong predictor of adverse cardiovascular events as well. 6 I wonder why the author did not analyze the data about myocardial salvage, whereas he got the point that myocardial salvage was of great importance to evaluate the effect of ischemic postconditioning.
Am Heart J 2015;169:e1. 0002-8703 http://dx.doi.org/10.1016/j.ahj.2015.01.004
Bing Zhang, MD Wei Chen, MD, PhD Fabao Gao, MD, PhD Department of Radiology West China Hospital Sichuan University Chengdu, China E-mail: [email protected]
References 1. Khan AR, Binabdulhak AA, Alastal Y, et al. Cardioprotective role of ischemic postconditioning in acute myocardial infarction: A systematic review and meta-analysis. Am Heart J 2014;168:512-21. [e514]. 2. Lonborg J, Kelbaek H, Vejlstrup N, 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. 3. Sorensson P, Saleh N, Bouvier F, et al. Effect of postconditioning on infarct size in patients with st elevation myocardial infarction. Heart 2010;96:1710-5. 4. Thuny F, Lairez O, Roubille F, 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. 5. Freixa X, Bellera N, Ortiz-Perez JT, et al. Ischaemic postconditioning revisited: Lack of effects on infarct size following primary percutaneous coronary intervention. Eur Heart J 2012;33:103-12. 6. Wei Y, Ruan L, Zhou G, et al. Local ischemic postconditioning during primary percutaneous coronary intervention: A meta-analysis. Cardiology 2012;123:225-33.
Letter to the editor regarding the article “Cardioprotective role of ischemic postconditioning in acute myocardial infarction: A systematic review and meta-analysis” To the Editor, We read the article by Khan et al 1 reporting the cardioprotective effects of ischemic postconditioning in acute myocardial infarction and were puzzled by the discussion “Our results suggest that myocardial salvage is better in the anterior location compared with the inferior location because of a greater myocardial area being at risk.” As we know, myocardial salvage is defined as the difference between area at risk (AAR) and infarct size. The authors just referred AAR and highlighted its importance in the discussion; however, they did not show us the analysis of AAR or myocardial salvage between ischemic postconditioning during percutaneous coronary intervention and percutaneous coronary intervention alone, although AAR or myocardial salvage was listed in several articles (just listing part of them) 2-5 included in the meta-analysis. Therefore, it is inappropriate for the author to state that myocardial salvage differed between 2 groups. Moreover, it is necessary to determine myocardial salvage while evaluating the efficacy of reperfusion therapy. Besides, myocardial salvage index, myocardial salvage index = AAR − infarct size/AAR, is considered to be a strong predictor of adverse cardiovascular events as well. 6 I wonder why the author did not analyze the data about myocardial salvage, whereas he got the point that myocardial salvage was of great importance to evaluate the effect of ischemic postconditioning.
Am Heart J 2015;169:e1. 0002-8703 http://dx.doi.org/10.1016/j.ahj.2015.01.004
Bing Zhang, MD Wei Chen, MD, PhD Fabao Gao, MD, PhD Department of Radiology West China Hospital Sichuan University Chengdu, China E-mail: [email protected]
References 1. Khan AR, Binabdulhak AA, Alastal Y, et al. Cardioprotective role of ischemic postconditioning in acute myocardial infarction: A systematic review and meta-analysis. Am Heart J 2014;168:512-21. [e514]. 2. Lonborg J, Kelbaek H, Vejlstrup N, 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. 3. Sorensson P, Saleh N, Bouvier F, et al. Effect of postconditioning on infarct size in patients with st elevation myocardial infarction. Heart 2010;96:1710-5. 4. Thuny F, Lairez O, Roubille F, 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. 5. Freixa X, Bellera N, Ortiz-Perez JT, et al. Ischaemic postconditioning revisited: Lack of effects on infarct size following primary percutaneous coronary intervention. Eur Heart J 2012;33:103-12. 6. Wei Y, Ruan L, Zhou G, et al. Local ischemic postconditioning during primary percutaneous coronary intervention: A meta-analysis. Cardiology 2012;123:225-33.
