Local ischemic post-conditioning: moving in the right direction?.

ly, methods were developed to use the angioplasty balloon within the infarct-related coronary artery to re-occlude blood flow and experimentally modify the early reperfusion phase. In this issue of Cardiology, Wei et al. [6] present a meta-analysis of 13 studies conducted between 2005 and 2011 involving a total of 673 patients, of which 352 were treated by local ischemic post-conditioning during PPCI. They report data relating to its effect on: (i) biochemical measures of infarct size, (ii) imaging measures of infarct size, (iii) indices of reperfusion (ST-segment resolution, blush grade and TIMI frame count), (iv) measures of left ventricular function and (v) clinical outcome measures [6] . They report a positive consistent effect of local ischemic post-conditioning on all of these measures, despite the varying protocols used in these studies. The reported 7.8% (95% CI 7.12–8.46) difference in LV ejection fraction at 3 months after the infarct is clinically meaningful, and there is a suggestion of reduced progression towards heart failure. Two other metaanalyses in this area strongly support these findings with regard to the effects on infarct size and LV ejection fraction [7, 8] .